Provider Demographics
NPI:1174895684
Name:ABUNDANT COMMUNITY RECOVERY SERVICES
Entity type:Organization
Organization Name:ABUNDANT COMMUNITY RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-881-3111
Mailing Address - Street 1:20267 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1831
Mailing Address - Country:US
Mailing Address - Phone:313-881-3111
Mailing Address - Fax:313-881-3120
Practice Address - Street 1:20267 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1831
Practice Address - Country:US
Practice Address - Phone:313-881-3111
Practice Address - Fax:313-881-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI823182251B00000X, 252Y00000X
MI3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency