| No | |
|
28359 Aline Dr Warren MI 48093-2675 | |
| (586) 741-5111 | |
| (586) 806-0411 |
| Full Name | No |
|---|---|
| Speciality | Social Worker |
| Location | 28359 Aline Dr, Warren, Michigan |
| Authorized Official Name and Position | Sharon Rose (SOLE MEMBER) |
| Authorized Official Contact | 5867415111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| No Po Box 1496 Warren MI 48090-1496 Ph: (586) 741-5111 | No 28359 Aline Dr Warren MI 48093-2675 Ph: (586) 741-5111 |
| NPI Number | 1487909545 |
|---|---|
| Provider Enumeration Date | 07/16/2012 |
| Last Update Date | 03/03/2022 |
| Certification Date | 03/03/2022 |
| Medicare PECOS PAC ID | 7315195450 |
|---|---|
| Medicare Enrollment ID | O20120914000765 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487909545 | NPI | - | NPPES |
| Provider Name | Sharon R Rose |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023116969 PECOS PAC ID: 9335041532 Enrollment ID: I20040127000022 |
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