Organization
MICHIGAN SHARE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADA MCMILLAN (PROVIDER)
(586) 453-8676
Entity
Organization
Contact information
Practice address
22022 OCONNOR ST, SAINT CLAIR SHORES, MI 48080-2043
(586) 350-0675
(586) 362-8334
Mailing address
PO BOX 404, SAINT CLAIR SHORES, MI 48080-0404
(586) 350-0675
(586) 362-8334
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
AS500011871
MI
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
AS500011889
MI
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
AS500011897
MI
Other
Enumeration date
05/05/2017
Last updated
05/05/2017
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