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NPI 1215266259 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Clinton Twp, MI
Provider details
- NPI number
- 1215266259
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Latasha Pemberton, Owner(313) 743-2462
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
Practice location
24145 Grange St
Clinton Twp, MI 48036-3008
Phone: (313) 743-2462
Approximate (ZIP-level) locationGet directions
Mailing address
24145 Grange St
Clinton Twp, MI 48036-3008
Registry dates
- Enumerated
- 2009-12-22
- Last updated
- 2009-12-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.