NCADD-IMPACT ADOLESCENT HEALTH CENTER (NPI# 1134341092) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134341092 |
| Entity Type | Organization |
| Organization Name | NCADD-IMPACT ADOLESCENT HEALTH CENTER |
| Practice Address |
5555 Conner St 2000 North Detroit MI 48213-3448 |
| Mailing Address |
488 Frazier St River Rouge MI 48218-1025 |
| Practice Telephone | 3139218102 |
| Practice Fax Number | 3139214184 |
| Mailing Telephone | 3135513815 |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2008-08-14 |
| Authorized Official Name | MS. LAVERNE DENISE MCGLOTHIAN (OFFICE MANAGER) |
| Authorized Official Telephone | 3139218102 |
| Authorized Official Credential | FOADP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | C1820235935 | MI | Residential Treatment Facilities |
| Street Address |
5555 CONNER ST 2000 NORTH |
| City | DETROIT |
| State | MI |
| Zip Code | 48213-3448 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245237551 | Mary L Serowoky | Nurse Practitioner | 5555 Conner St, St 2691, Detroit, MI 48213-3448 | 2005-06-30 |
| 1902422751 | Dhaara Antani | Dietitian, Registered | 5555 Conner St, Detroit, MI 48213-3448 | 2020-06-17 |
| 1164066643 | Bethany J. Howard | Case Manager/Care Coordinator | 5555 Conner St, Detroit, MI 48213-3448 | 2019-10-29 |
| 1699234153 | Madison Community Hospital Inc | Nurse Practitioner | 5555 Conner St, Detroit, MI 48213-3448 | 2019-03-14 |
| 1700357563 | Ashley Henninger | Speech-Language Pathologist | 5555 Conner St, Detroit, MI 48213-3448 | 2018-12-05 |
| 1720564651 | Metropolitan Detroit Center for Independent Living | Case Management | 5555 Conner St, Detroit, MI 48213-3448 | 2018-07-13 |
| 1386158962 | Sharon Diane Fowler | Counselor | 5555 Conner St, Detroit, MI 48213-3448 | 2017-11-19 |
| 1346605847 | Shannon Crumbley | In Home Supportive Care | 5555 Conner St, 2079c, Detroit, MI 48213-3448 | 2015-12-28 |
| 1083080121 | Sonya Shelman | Social Worker | 5555 Conner St, Detroit, MI 48213-3448 | 2015-08-12 |
| 1629450960 | Marquetta Turner | Social Worker | 5555 Conner St, Suite 1038, Detroit, MI 48213-3448 | 2015-06-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215540430 | Sheronda Lanetta Blackmon | Licensed Practical Nurse | 13929 Harper Ave., Detroit, MI 48213 | 2020-08-27 |
| 1073049144 | Cheryl Williams | Community Health Worker | 13929 Chalmers Ave., Detroit, MI 48213 | 2017-05-10 |
| 1164963401 | Smile Fresh Detroit PC | Dentist | 7230 Gratiot Avenue, Detroit, MI 48213 | 2017-03-20 |
| 1255887899 | Jay Washington | Behavioral Analyst | 9146 Haper, Detroit, MI 48213 | 2016-09-01 |
| 1396129532 | Sarietha King | Home Health | 14639 Manistique, Detroit, MI 48213 | 2015-07-17 |
| 1366823197 | Royal Treatment Mental Health Systems, LLC | Counselor | 5555 Corner Avenue, Detroit, MI 48213 | 2015-06-17 |
| 1477956779 | Monique Powell | Student in an Organized Health Care Education/Training Program | 5801 Lakeview S.t, Detroit, MI 48213 | 2014-09-30 |
| 1629339163 | Samuel Joseph Farmer | Counselor | 10100 Harper Ave., Detroit, MI 48213 | 2012-05-31 |
| 1609164755 | Vernon Keith Johnson | Social Worker | 20203 Kelly Road, Detroit, MI 48213 | 2011-07-11 |
| 1023312790 | Davenport Quality Home Care LLC | Home Health | 5027 Maxwell, Detroit, MI 48213 | 2011-01-10 |
| Find all providers in zip 48213 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457718165 | Shar Inc. | Substance Abuse Rehabilitation Facility | 9961 Patton St, Detroit, MI 48228-1217 | 2016-01-26 |
| 1073988333 | Sobriety House | Substance Abuse Rehabilitation Facility | 2150 E Vernor Hwy, Apt 413, Detroit, MI 48207-2744 | 2015-12-11 |
| 1003180902 | Cherry Streat Health Services | Substance Abuse Rehabilitation Facility | 11105 E Jefferson Ave, Detroit, MI 48214-3317 | 2012-02-24 |
| 1871866475 | Positive Images | Substance Abuse Rehabilitation Facility | 13336 E.warren, Detroit, MI 48229 | 2012-02-14 |
| 1861778680 | Pure Recovery Inc. | Substance Abuse Rehabilitation Facility | 19406 Norwood St, Detroit, MI 48234-1870 | 2011-10-25 |
| 1396047239 | Renaissance Recovery | Substance Abuse Rehabilitation Facility | 5250 John R St, Detroit, MI 48202-4030 | 2010-11-29 |
| 1912227075 | Juda Transitional & Recovery House | Substance Abuse Rehabilitation Facility | 5579 Vancouver St, Detroit, MI 48204-3607 | 2010-06-10 |
| 1386974913 | Stategies of Life Outreach Centers | Substance Abuse Rehabilitation Facility | 17850 Mcdougall St, Detroit, MI 48212-1040 | 2010-01-04 |
| 1922335181 | Robert IIi Baptiste Thompson | Substance Abuse Rehabilitation Facility | 2616 Puritan St, Detroit, MI 48238-1420 | 2009-11-09 |
| 1013143676 | Marian's Center for Woman's Growth | Substance Abuse Rehabilitation Facility | 5247 Sheridan St, Detroit, MI 48213-2868 | 2009-06-09 |
| Find all providers in DETROIT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.