Organization
INNER MAN WELLNESS AND SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RODERICK GILLISON (EXECUTIVE DIRECTOR)
(248) 802-2712
Entity
Organization
Contact information
Practice address
4890 BALLANTRAE RD, BLOOMFIELD, MI 48301-1000
(248) 802-2712
Mailing address
4890 BALLANTRAE RD, BLOOMFIELD, MI 48301-1000
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
03/21/2019
Last updated
03/21/2019
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