Basic Information
| Provider Information | |||||||||
| NPI: | 1700287612 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NAOMI NEST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 245 PITKIN ST | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482033737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138651500 | ||||||||
| FaxNumber: | 3138651477 | ||||||||
| Practice Location | |||||||||
| Address1: | 245 PITKIN ST | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482033737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138651500 | ||||||||
| FaxNumber: | 3138651477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2014 | ||||||||
| LastUpdateDate: | 09/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | EADDY | ||||||||
| AuthorizedOfficialFirstName: | TRACEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRIMARY THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3138651500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MSW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 6801094574 | MI | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.