Basic Information
| Provider Information | |||||||||
| NPI: | 1215470067 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARVEST RETREAT DROP-IN CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21840 HARDING ST | ||||||||
| Address2: | |||||||||
| City: | OAK PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482372523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482989215 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16300 WOODWARD AVE | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482032882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482989215 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2016 | ||||||||
| LastUpdateDate: | 11/28/2016 | ||||||||
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| AuthorizedOfficialLastName: | PENN-JEWELL | ||||||||
| AuthorizedOfficialFirstName: | MELLANIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2482989215 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA, LLPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.