Provider Demographics
NPI:1174992796
Name:WARREN MEDICAL AND THERAPY CENTER, LLC
Entity type:Organization
Organization Name:WARREN MEDICAL AND THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-254-9659
Mailing Address - Street 1:15841 W WARREN AVE
Mailing Address - Street 2:#37
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3737
Mailing Address - Country:US
Mailing Address - Phone:313-254-9659
Mailing Address - Fax:
Practice Address - Street 1:15841 W WARREN AVE
Practice Address - Street 2:#37
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3737
Practice Address - Country:US
Practice Address - Phone:313-254-9659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service