Provider Demographics
NPI:1003473091
Name:CENTER FOR ESTABLISHING RECOVERY
Entity Type:Organization
Organization Name:CENTER FOR ESTABLISHING RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KORI
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:LOEWE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, CAADC
Authorized Official - Phone:313-288-2689
Mailing Address - Street 1:1209 CATALPA DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1162
Mailing Address - Country:US
Mailing Address - Phone:313-288-2689
Mailing Address - Fax:
Practice Address - Street 1:100 RIVERFRONT DR APT 2610
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-4542
Practice Address - Country:US
Practice Address - Phone:313-288-2689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1912103490Medicaid