| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1861 E. Maple, Troy, Michigan |
| Authorized Official Name and Position | Sylvia Rose Johnson (CEO) |
| Authorized Official Contact | 2483305770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1861 E. Maple Troy MI 48083 Ph: (248) 246-0172 | 1861 E. Maple Troy MI 48083 Ph: (248) 330-5770 |
| NPI Number | 1588357461 |
|---|---|
| Provider Enumeration Date | 05/29/2023 |
| Last Update Date | 04/16/2024 |
| Certification Date | 04/16/2024 |
| Medicare PECOS PAC ID | 0446693519 |
|---|---|
| Medicare Enrollment ID | O20240610000498 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588357461 | NPI | - | NPPES |
| Provider Name | Sylvia R Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104317171 PECOS PAC ID: 1254680085 Enrollment ID: I20180827003790 |
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