1104440320 NPI number — HOW- SUBSTANCE ABUSE ABUSE PROGRAM

Table of content: (NPI 1104440320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104440320 NPI number — HOW- SUBSTANCE ABUSE ABUSE PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOW- SUBSTANCE ABUSE ABUSE PROGRAM
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:
1104440320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51762 EVA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACOMB
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48042-4234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-842-0428
Provider Business Mailing Address Fax Number:
248-850-7424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8131 E OUTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48213-1323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-842-0428
Provider Business Practice Location Address Fax Number:
248-850-7424
Provider Enumeration Date:
06/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
FRANKLIN
Authorized Official First Name:
GREORY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
248-842-0428

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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