Provider Demographics
NPI:1356869572
Name:AMERICA RECOVERY CENTER, PLLC
Entity type:Organization
Organization Name:AMERICA RECOVERY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-820-1712
Mailing Address - Street 1:6867 SNOW APPLE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1635
Mailing Address - Country:US
Mailing Address - Phone:248-820-1712
Mailing Address - Fax:
Practice Address - Street 1:20217 ANN ARBOR TRL
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2692
Practice Address - Country:US
Practice Address - Phone:313-395-3444
Practice Address - Fax:313-395-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055667207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty