Provider Demographics
NPI:1205382389
Name:B&R HOLISTIC CARE HOUSING, LLC
Entity Type:Organization
Organization Name:B&R HOLISTIC CARE HOUSING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:ODESSA
Authorized Official - Last Name:ROSSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-293-4268
Mailing Address - Street 1:3832 MIRACLES BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1515
Mailing Address - Country:US
Mailing Address - Phone:313-293-4268
Mailing Address - Fax:
Practice Address - Street 1:19303 MARK TWAIN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1914
Practice Address - Country:US
Practice Address - Phone:313-850-6052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIE8830U3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness