| Street Life Recovery Program | |
|
14703 Allen Rd Ste 104 Southgate MI 48195-2594 | |
| (734) 496-5599 | |
| Not Available |
| Full Name | Street Life Recovery Program |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 14703 Allen Rd Ste 104, Southgate, Michigan |
| Authorized Official Name and Position | Edward Ian Robinson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7344965599 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Street Life Recovery Program 14703 Allen Rd Ste 104 Southgate MI 48195-2594 Ph: (734) 496-5599 | Street Life Recovery Program 14703 Allen Rd Ste 104 Southgate MI 48195-2594 Ph: (734) 496-5599 |
| NPI Number | 1982460234 |
|---|---|
| Provider Enumeration Date | 02/26/2024 |
| Last Update Date | 02/26/2024 |
| Certification Date | 02/23/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982460234 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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