Organization
OCTIROSE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TATISHA MILLER (DIRECTOR OF OPERATIONS)
(313) 405-7668
Entity
Organization
Contact information
Practice address
29488 WOODWARD AVE APT 234, ROYAL OAK, MI 48073-0903
(313) 405-7668
Mailing address
29488 WOODWARD AVE APT 234, ROYAL OAK, MI 48073-0903
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Enumeration date
05/13/2019
Last updated
05/13/2019
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