Provider Demographics
NPI:1194212613
Name:YVETTE HARDY PEBBLE BROOK CARE AGENCY INC
Entity Type:Organization
Organization Name:YVETTE HARDY PEBBLE BROOK CARE AGENCY INC
Other - Org Name:PEBBLE BROOK CARE AGENCY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:LARONIA
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-658-5420
Mailing Address - Street 1:15333 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-5187
Mailing Address - Country:US
Mailing Address - Phone:313-658-5420
Mailing Address - Fax:
Practice Address - Street 1:818 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1105
Practice Address - Country:US
Practice Address - Phone:313-658-5420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty