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Organization
COMMON GROUND
Active
Organization
COMMON GROUND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORRAYNE CARLESS (MANAGER)
(586) 995-3861
Entity
Organization
Contact information
Practice address
1200 TELEGRAPH RD, PONTIAC, MI 48341
(248) 541-3522
Mailing address
1200 N TELEGRAPH RD, PONTIAC, MI 48341-1032
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
4704157745
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704157745
LICENSE NUMBER
MI
Enumeration date
06/25/2014
Last updated
06/25/2014
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