1558883652 NPI number — DESJARDINS THERAPEUTIC SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558883652 NPI number — DESJARDINS THERAPEUTIC SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESJARDINS THERAPEUTIC SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558883652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
575 E BIG BEAVER RD STE 260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48083-1362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-890-3047
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3190 ROCHESTER RD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48083-5464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-890-3047
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
DESJARDINS
Authorized Official First Name:
CAITLIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
248-890-3047

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1467836320 . This is a "NPPES" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com