MS. CAROLE ELYSE DIX (NPI# 1265602288) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265602288 |
| Entity Type | Individual |
| Full Name | MS. CAROLE ELYSE DIX |
| Credential | LMSW |
| Practice Address |
4646 John R St Detroit MI 48201-1916 |
| Practice Telephone | 3156761555 |
| Practice Fax Number | 3135761570 |
| Mailing Telephone | 3156761555 |
| Mailing Fax Number | 3135761570 |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2008-03-05 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 323P00000X | Psychiatric Residential Treatment Facility | 6801034135 | MI | Residential Treatment Facilities |
| Street Address |
4646 JOHN R ST |
| City | DETROIT |
| State | MI |
| Zip Code | 48201-1916 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356344121 | Christopher Emil Hermann | Nurse Practitioner | 4646 John R St, Detroit, MI 48201-1916 | 2005-05-24 |
| 1881293892 | Derrick Williams | Registered Nurse | 4646 John R St, Detroit, MI 48201-1916 | 2020-10-21 |
| 1598371544 | Sonia Govil | Dietitian, Registered | 4646 John R St, Detroit, MI 48201-1916 | 2020-09-16 |
| 1740893569 | Nicholas Edward Peters | Pharmacist | 4646 John R St, Detroit, MI 48201-1916 | 2020-08-31 |
| 1710597455 | Amber Michelle Young | Social Worker | 4646 John R St, Detroit, MI 48201-1916 | 2020-08-07 |
| 1104434471 | Zeinab H Moussa | Pharmacist | 4646 John R St, Detroit, MI 48201-1916 | 2020-07-22 |
| 1235747346 | Samantha Beth Lewis | Psychologist | 4646 John R St, Detroit, MI 48201-1916 | 2020-07-15 |
| 1477171189 | Rima Mohammad Fardos | Pharmacist | 4646 John R St, Detroit, MI 48201-1916 | 2020-07-09 |
| 1992323869 | Sarah F Waqhar | Student in an Organized Health Care Education/Training Program | 4646 John R St, Detroit, MI 48201-1916 | 2020-07-08 |
| 1619594181 | Mellisa Ann Boyle | Student in an Organized Health Care Education/Training Program | 4646 John R St, Detroit, MI 48201-1916 | 2020-07-01 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659989838 | Saima Sharif | Student in an Organized Health Care Education/Training Program | 4201 St Antoine St 9c-uhc Detroit Education & Research, Detroit, MI 48201 | 2020-07-14 |
| 1609494384 | Praveen Kumar Boddu | Student in an Organized Health Care Education/Training Program | 3901,beaubien, Ste 3t72, Children's Hospital, Detroit, MI 48201 | 2020-07-09 |
| 1730707720 | Amr Hassan Abdelghaffar Omar | Pediatrics | 3901 Beaubien St Room 3t72, Children's Hospital of Michigan, Detroit, MI 48201 | 2020-07-07 |
| 1700400694 | Hassan Imtiaz | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine 8c-uhc, Detroit Medical Center, Detroit, MI 48201 | 2020-06-05 |
| 1598389074 | Alaa Awad Elkarim | Student in an Organized Health Care Education/Training Program | 3901 Beaubien St. 3t72, Detroit, MI 48201 | 2020-06-01 |
| 1891319299 | Jeongyeon Hwang | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street University Health Center - 8c, Detroit, MI 48201 | 2020-06-01 |
| 1477176576 | Jaudat Fatima Masood | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street, University Health Center - 8c, Detroit, MI 48201 | 2020-05-22 |
| 1205459419 | Amit Kumar Dahiya | Student in an Organized Health Care Education/Training Program | 11201 St. Antoine, Room 2e Uhc, Detroit, MI 48201 | 2020-05-21 |
| 1851914188 | Asra Nausheen Shaik | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine St, Room 2e-uhc, Detroit, MI 48201 | 2020-05-21 |
| 1568085751 | Camille Olechowski | Student in an Organized Health Care Education/Training Program | 3901 Chrysler Dr. Detroit Medical Center, Room 5-a 538.1, Detroit, MI 48201 | 2020-05-21 |
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| Taxonomy Code | 323P00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Psychiatric Residential Treatment Facility |
| A residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient’s surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary |
| Notes: Source: Champus Policy manual, Volume II, p. 6010.47M dated 9/12/94. Revision: Definition title revised 7/1/03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598120925 | Faith's Place LLC | Psychiatric Residential Treatment Facility | 16725 Blackstone Street, Detroit, MI 48219 | 2015-12-30 |
| 1164753828 | Is-care Cls, Inc. | Psychiatric Residential Treatment Facility | 1777 N Rademacher St, Detroit, MI 48209-2049 | 2010-01-20 |
| 1356511372 | Detroit Behavioral Institute, LLC | Psychiatric Residential Treatment Facility | 3500 John R St, Detroit, MI 48201-2402 | 2008-03-05 |
| 1154781615 | Detroit Vamc | Psychiatric Residential Treatment Facility | 4777 E Outer Dr, Detroit, MI 48234-3241 | 2016-02-26 |
| 1386832491 | Tgw Medical Inc | Psychiatric Residential Treatment Facility | 8537 Van Dyke St, Detroit, MI 48213-2374 | 2007-10-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164837431 | Common Ground | Psychiatric Residential Treatment Facility | 1200 Telegraph Rd, Pontiac, MI 48341 | 2014-06-25 |
| 1104249374 | Common Ground | Psychiatric Residential Treatment Facility | 1410 Telegraph Road, Pontiac, MI 48332 | 2014-01-24 |
| 1881961498 | The Meadows Specialized Residential Program | Psychiatric Residential Treatment Facility | 55377 Walterspaugh Rd, Mendon, MI 49072-9545 | 2011-11-27 |
| 1518129295 | Advance Care Incorporated | Psychiatric Residential Treatment Facility | 34932 Ecorse Rd, Romulus, MI 48174-1642 | 2008-06-25 |
| 1245375823 | D & M Consultants, Inc | Psychiatric Residential Treatment Facility | 25071 West Ten Mile Road, Southfield, MI 48033 | 2007-02-21 |
| 1578582672 | Ccs/lansing, Inc | Psychiatric Residential Treatment Facility | 101 W Townsend Rd, Saint Johns, MI 48879-9200 | 2006-07-19 |
| 1710351598 | Eagle Village | Psychiatric Residential Treatment Facility | 4507 170th Ave, Hersey, MI 49639-8785 | 2015-11-17 |
| 1407228091 | Cynthia Lajoice Ford | Psychiatric Residential Treatment Facility | 1110 Eldon Baker Dr, Flint, MI 48507-1923 | 2015-10-22 |
| 1871831750 | Wolverine Human Services | Psychiatric Residential Treatment Facility | 150 Enterprise Dr, Vassar, MI 48768-9584 | 2013-01-28 |
| 1295082188 | Hope Network Genesee Regional Cru | Psychiatric Residential Treatment Facility | 70 Lafayette St, Pontiac, MI 48342-2033 | 2012-08-09 |
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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.