CENTRIA HEALTHCARE LLC (NPI# 1730586710) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730586710 |
| Entity Type | Organization |
| Organization Name | CENTRIA HEALTHCARE LLC |
| Other Organization Name | CENTRIA HEALTHCARE - DEARBORN CENTER |
| Practice Address |
19855 Outer Dr Suite 101 Dearborn MI 48124-2022 |
| Mailing Address |
41521 W 11 Mile Rd Novi MI 48375-1803 |
| Practice Telephone | 2482990030 |
| Mailing Telephone | 2482990030 |
| Mailing Fax Number | 2489121566 |
| Enumeration Date | 2014-11-19 |
| Last Update Date | 2014-12-09 |
| Authorized Official Name | CHRISTOPHER WILCOX (PRESIDENT) |
| Authorized Official Telephone | 2482990030 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Centria Healthcare - Dearborn Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093112070 | Centria Healthcare LLC | Clinic/Center | 13101 Allen Rd, Building #5, Southgate, MI 48195-2216 | 2014-11-19 |
| 1053641498 | Centria Healthcare LLC | Home Infusion | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5326 | 2010-01-07 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CENTRIA HEALTHCARE LLC | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5326 |
| Virginia Business Entities | Centria Healthcare LLC | 27777 Inkster Road, Suite 100, Farmington Hills, Michigan 48334 |
| Colorado Business Entities | Centria Healthcare LLC | 27777 Inkster Rd., Ste. 100, Farmington Hills, MI 48334 |
| Washington State Corporations | CENTRIA HEALTHCARE LLC | 4816 Aurora Ave N, Seattle, WA 98103 |
| Oregon Corporations, Companies and Business Names | CENTRIA HEALTHCARE LLC | 27777 Inkster, Suite 100, Farmington Hills, MI 48334 |
| Indiana Business Entities | CENTRIA HEALTHCARE LLC | 41521 W 11 Mile Rd, Novi, MI 48375 |
| Street Address |
19855 OUTER DR SUITE 101 |
| City | DEARBORN |
| State | MI |
| Zip Code | 48124-2022 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821077082 | Susan Greenshields | Psychologist | 19855 Outer Dr, Suite 103a, Dearborn, MI 48124-2022 | 2006-01-15 |
| 1316458649 | Katherine A Melchior Phd LLC | Psychologist | 19855 Outer Dr, Dearborn, MI 48124-2022 | 2017-10-13 |
| 1043688674 | Reconna Marshall | Behavior Technician | 19855 Outer Dr, Dearborn, MI 48124-2022 | 2015-09-14 |
| 1366867699 | Michele Dombrowski | Social Worker | 19855 Outer Dr, Dearborn, MI 48124-2022 | 2014-02-24 |
| 1760813901 | Ruth Moore-russell | Case Manager/Care Coordinator | 19855 Outer Dr, Suite 104, Dearborn, MI 48124-2022 | 2013-12-12 |
| 1629318126 | Hadassah & Company Pllc | Community/Behavioral Health | 19855 Outer Dr, Suite 504e, Dearborn, MI 48124-2022 | 2013-02-20 |
| 1366789224 | Family Services | Community/Behavioral Health | 19855 Outer Dr, Ste.104, Dearborn, MI 48124-2022 | 2013-01-12 |
| 1023368396 | Dale William Zamecki | Counselor | 19855 Outer Dr, Dearborn, MI 48124-2022 | 2012-09-14 |
| 1215208210 | Nikki Yolanda Jones | Counselor | 19855 Outer Dr, Dearborn, MI 48124-2022 | 2012-01-23 |
| 1346411220 | Penelope Hale Phd PC | Psychologist | 19855 Outer Dr, Suite 103w, Dearborn, MI 48124-2022 | 2008-03-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396389524 | Pharma A, LLC | Pharmacy | 23916 Michigan Ave, Dearborn, MI 48124 | 2019-10-31 |
| 1225683725 | Aysha Said | Behavior Technician | 1369 Porter St, Dearborn, MI 48124 | 2019-08-02 |
| 1881257772 | Leen Nusairat | Internal Medicine | Beaumont Health-dearborn Campus, 18101 Oakwood Blvd, Dearborn, MI 48124 | 2019-04-17 |
| 1417413360 | Gary C. Veraghen, Dds, PC | Dentist | 22100 W. Outer Drive, Dearborn, MI 48124 | 2019-02-15 |
| 1982168787 | Fnu Asma Manzar | Physical Therapist | Global Physical Therapy Services, Inc, 22819 Michigan Avenue, Dearborn, MI 48124 | 2019-01-25 |
| 1639640162 | Jernia Lashawn Usher | Behavior Technician | 1360 Porter St Lower Level, Dearborn, MI 48124 | 2018-12-10 |
| 1710456470 | Samar Fouad Hannawi | Psychologist | 3815 Pelham Street, Suite #13, Dearborn, MI 48124 | 2018-11-24 |
| 1881178747 | Sarah Chehab | Psychologist | 835 Mason St Suite 220b, Dearborn, MI 48124 | 2018-09-17 |
| 1568948289 | Ibrahim M Basma | Pharmacist | 22521 Michigan Avenue, Dearborn, MI 48124 | 2018-07-16 |
| 1669961942 | Jacqueline E Domzalski | Technician, Other | 3231 S. Gulley, Suite E, Dearborn, MI 48124 | 2018-05-02 |
| Find all providers in zip 48124 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669834040 | American Phsychiatric & Neuroscience Institute PC | Clinic/Center | 30 Bradford Ct, Dearborn, MI 48126-4169 | 2016-03-24 |
| 1891075958 | Henry Ford Health System | Clinic/Center | 5111 Auto Club Dr, Suite 112 Bldig 5, Dearborn, MI 48126-2749 | 2011-08-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477151751 | Fully Alive Therapeutic Services, LLC | Clinic/Center | 32910 W 13 Mile Rd Ste D-402, Farmington Hills, MI 48334-1980 | 2020-10-09 |
| 1720614530 | Oakland Integrated Healthcare Network | Clinic/Center | 125 W Montcalm St Rm 101, Pontiac, MI 48342-1141 | 2020-03-13 |
| 1588203491 | Heron Ridge Associates Plc | Clinic/Center | 3300 Washtenaw Ave Ste 265, Ann Arbor, MI 48104-4200 | 2019-12-26 |
| 1972141406 | Reliance Counseling, LLC. | Clinic/Center | 11126 Wayne Rd # 2, Romulus, MI 48174-1473 | 2019-12-16 |
| 1629639190 | Pathway Psychological Services Pllc | Clinic/Center | 22750 Woodward Ave Ste 211, Ferndale, MI 48220-1753 | 2019-06-25 |
| 1790344281 | Yearego Professional Counseling | Clinic/Center | 81 Indianwood Rd Ste 2, Lake Orion, MI 48362-1595 | 2019-06-10 |
| 1992268627 | Kalamazoo Empowerment Services, Plc | Clinic/Center | 350 E Michigan Ave Ste 421, Kalamazoo, MI 49007-3855 | 2019-04-10 |
| 1922571041 | Repairer of The Breach Counseling and Consultant Services, LLC | Clinic/Center | 319 Chandler St, Detroit, MI 48202-2857 | 2019-01-11 |
| 1093285652 | The Caerus Group LLC | Clinic/Center | 732 S. 11th St #197, Niles, MI 49120 | 2018-11-27 |
| 1972073633 | Hidden Brook Counseling Services, Pllc | Clinic/Center | 2202 Mitchell Park Dr Ste 2b, Petoskey, MI 49770-8897 | 2018-11-26 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on CENTRIA HEALTHCARE LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.