Basic Information
| Provider Information | |||||||||
| NPI: | 1023225539 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ELMHURST HOME, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1981 W MCNICHOLS RD | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482034204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138671090 | ||||||||
| FaxNumber: | 3138670706 | ||||||||
| Practice Location | |||||||||
| Address1: | 1981 W MCNICHOLS RD | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482034204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138671090 | ||||||||
| FaxNumber: | 3138670706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PATTMAN | ||||||||
| AuthorizedOfficialFirstName: | ETHEL | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | INTAKE COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 3138671002 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | FOAD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.