| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 11800 E 12 Mile Rd, Warren, Michigan |
| Authorized Official Name and Position | Terence Hamilton (PRESIDENT) |
| Authorized Official Contact | 5865735904 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
28000 Dequindre Rd Warren MI 48092-2468 Ph: (586) 753-0260 | 11800 E 12 Mile Rd Warren MI 48093 Ph: (586) 573-5000 |
| NPI Number | 1306816426 |
|---|---|
| Provider Enumeration Date | 01/23/2006 |
| Last Update Date | 12/12/2019 |
| Certification Date | 12/12/2019 |
| Medicare PECOS PAC ID | 7315859725 |
|---|---|
| Medicare Enrollment ID | O20070615000164 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306816426 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
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