Organization
GILBERT
Active
Parent organization
SELF
Other names
Self
Organization subpart
Yes
Provider details
NPI number
Legal business name
SELF
Authorized official
MR. GILBERT J JOHNSON (CARE GIVER)
(313) 850-5205
Entity
Organization
Contact information
Practice address
15800 FAIRMOUNT DR, DETROIT, MI 48205-1448
(313) 850-5205
Mailing address
15800 FAIRMOUNT DR, DETROIT, MI 48205-1448
(313) 850-5205
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Enumeration date
08/06/2015
Last updated
08/06/2015
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