Individual
EBONY PUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
16581 FREELAND ST, DETROIT, MI 48235-4058
(313) 400-3531
Mailing address
1135 S MAIN ST STE 215, BOWLING GREEN, OH 43402-4750
(501) 539-5015
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
—
—
171WV0202X
Vehicle Modifications Contractor
—
—
172A00000X
Driver
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
10/25/2022
Last updated
10/25/2022
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