Individual
GAVEN A BERTRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2444 OAKRIDGE DR, FLINT, MI 48507-6211
(810) 766-9377
Mailing address
1330 KENNETH ST, BURTON, MI 48529-2206
(810) 766-9377
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
AS250414567
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
AS250414567
MI
Other
Enumeration date
03/01/2023
Last updated
03/01/2023
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