Basic Information
| Provider Information | |||||||||
| NPI: | 1164599544 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FUTURES HEALTHCORE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 136 WILLIAM ST | ||||||||
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| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011052349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002189280 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3101 S GULLEY RD | ||||||||
| Address2: | SUITE F | ||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481244406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344072500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 08/06/2015 | ||||||||
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| AuthorizedOfficialLastName: | GANNON | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | REGIONAL DIRECTOR OF MICHIGAN | ||||||||
| AuthorizedOfficialTelephone: | 7344072500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | M.A., CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 103T00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 133V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 261QC1500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.