# GERIATRIC PSYCHIATRIC SERVICES PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GERIATRIC PSYCHIATRIC SERVICES
- **Other names:** Nurse Practitioner Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1104063239
- **Legal business name:** GERIATRIC PSYCHIATRIC SERVICES
- **Authorized official:** ROBERT A CLEMENTE (MANAGER)
- **Authorized official phone:** (586) 620-8100

## Contact information

- **Practice address:** 28800 RYAN RD, SUITE 320, WARREN, MI 48092-4272
- **Practice address phone:** (586) 620-8100
- **Practice address fax:** (866) 227-7418
- **Mailing address:** 39465 W 14 MILE RD, NOVI, MI 48377-1600
- **Mailing address phone:** (248) 859-3900
- **Mailing address fax:** (888) 483-0118

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AM0700X | Medical Physician Assistant | — | NULL | — |
| 363AM0700X | Medical Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 364SA2200X | Adult Health Clinical Nurse Specialist | — | NULL | — |
| 364SA2200X | Adult Health Clinical Nurse Specialist | — | — | — |
| 364SP0809X | Adult Psychiatric/Mental Health Clinical Nurse Specialist | — | NULL | — |
| 364SP0809X | Adult Psychiatric/Mental Health Clinical Nurse Specialist | — | — | — |

## Other

- **Enumeration date:** 01/12/2009
- **Last updated:** 07/25/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 500F339520 | BCBS PIN NUMBER | MI |