Organization
COMMON GROUND SANTUARY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BARBARA TANYA-JACKNOW SHREVE R.N, (STAFF NURSE)
(248) 456-8150
Entity
Organization
Contact information
Practice address
461 W HURON ST, SUITE 100, PONTIAC, MI 48341-1601
(248) 456-1991
Mailing address
1410 S TELEGRAPH RD, BLOOMFIELD HILLS, MI 48302-0046
(248) 456-8150
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
4704150668
MI
Other
Enumeration date
06/18/2013
Last updated
06/18/2013
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