Provider Demographics
NPI:1174248066
Name:COMMON GROUND
Entity type:Organization
Organization Name:COMMON GROUND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH INFORMATION
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-451-3760
Mailing Address - Street 1:1410 S TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0046
Mailing Address - Country:US
Mailing Address - Phone:248-451-3760
Mailing Address - Fax:248-481-8669
Practice Address - Street 1:1410 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48302-0046
Practice Address - Country:US
Practice Address - Phone:248-451-3760
Practice Address - Fax:248-481-8669
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMON GROUND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care