Provider Demographics
NPI:1114348695
Name:COMMON GROUND
Entity Type:Organization
Organization Name:COMMON GROUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:PRELLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-554-5818
Mailing Address - Street 1:34971 AQUARIUS DR
Mailing Address - Street 2:APT D
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5633
Mailing Address - Country:US
Mailing Address - Phone:248-554-5818
Mailing Address - Fax:
Practice Address - Street 1:461 W HURON ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1601
Practice Address - Country:US
Practice Address - Phone:248-857-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit