Organization
CENTRIA HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIANNE DENISE RODEN COTA/L (COTA/L)
(313) 316-0923
Entity
Organization
Contact information
Practice address
7893 HARDING ST, TAYLOR, MI 48180-2535
(313) 316-0923
Mailing address
7893 HARDING ST, TAYLOR, MI 48180-2535
(313) 316-0923
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
5202001741
MI
261Q00000X
Clinic/Center
5202001741
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5202001741
ALL OTHER INSURANCE COMPANY
MI
05
—
5202001741
—
MI
Enumeration date
12/03/2014
Last updated
12/03/2014
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