Provider Demographics
NPI:1861787913
Name:PRATT'S PLACE LLC
Entity type:Organization
Organization Name:PRATT'S PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:VISTA-MARIA
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:313-655-5921
Mailing Address - Street 1:28290 TAVISTOCK TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5181
Mailing Address - Country:US
Mailing Address - Phone:313-655-5921
Mailing Address - Fax:
Practice Address - Street 1:8010 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-2940
Practice Address - Country:US
Practice Address - Phone:313-655-5921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820308702311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home