Provider Demographics
NPI:1083981724
Name:STEPHEN BURDEN DBA MARY LEE COMMUNITY HEALTH & TRAINING CENTER
Entity Type:Organization
Organization Name:STEPHEN BURDEN DBA MARY LEE COMMUNITY HEALTH & TRAINING CENTER
Other - Org Name:MARY LEE COMMUNITY HEALTH & TRAINING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:MARETTA
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, NP-C
Authorized Official - Phone:313-286-3031
Mailing Address - Street 1:24633 PEMBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3159
Mailing Address - Country:US
Mailing Address - Phone:248-719-4335
Mailing Address - Fax:
Practice Address - Street 1:25822 W 6 MILE RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-2211
Practice Address - Country:US
Practice Address - Phone:313-286-3031
Practice Address - Fax:313-286-3135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health