Provider Demographics
NPI:1164961033
Name:ANNEDON BURTON LLC
Entity Type:Organization
Organization Name:ANNEDON BURTON LLC
Other - Org Name:STRIVE CENTER FOR AUTISM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-403-9776
Mailing Address - Street 1:G4476 S. DORT HWY
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-1806
Mailing Address - Country:US
Mailing Address - Phone:810-344-8082
Mailing Address - Fax:810-222-0279
Practice Address - Street 1:G4476 S. DORT HWY
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-1806
Practice Address - Country:US
Practice Address - Phone:810-344-8082
Practice Address - Fax:810-222-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-02-1007103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty