Provider Demographics
NPI:1093105900
Name:CENTRIA HEALTH CARE
Entity Type:Organization
Organization Name:CENTRIA HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ABA
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:LAYVETTE
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-685-8733
Mailing Address - Street 1:19104 ELKHART ST
Mailing Address - Street 2:19104 ELKHART
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-2108
Mailing Address - Country:US
Mailing Address - Phone:313-685-8733
Mailing Address - Fax:
Practice Address - Street 1:19104 ELKHART ST
Practice Address - Street 2:19104 ELKHART
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-2108
Practice Address - Country:US
Practice Address - Phone:313-685-8733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty