Provider Demographics
NPI:1902282015
Name:ADULT WELL-BEING SERVICES
Entity Type:Organization
Organization Name:ADULT WELL-BEING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTRIM PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-825-2410
Mailing Address - Street 1:1423 FIELD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-2321
Mailing Address - Country:US
Mailing Address - Phone:313-825-2410
Mailing Address - Fax:313-924-0350
Practice Address - Street 1:1423 FIELD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-2321
Practice Address - Country:US
Practice Address - Phone:313-825-2410
Practice Address - Fax:313-924-0350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADULT WELL-BEING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty