1598182396 NPI number — THERAPEUTIC ADVENTURES

Table of content: (NPI 1598182396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598182396 NPI number — THERAPEUTIC ADVENTURES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPEUTIC ADVENTURES
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:
1598182396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11096 WATERSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVISBURG
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48350-3561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-892-1578
Provider Business Mailing Address Fax Number:
248-625-9203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8896 COMMERCE RD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMMERCE TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48382-4494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-892-1578
Provider Business Practice Location Address Fax Number:
248-625-9203
Provider Enumeration Date:
03/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ARROL
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
OCCUPATIONAL THERAPY/OWNER
Authorized Official Telephone Number:
248-892-1578

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1891909412 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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