Provider Demographics
NPI:1235542960
Name:HARNOMY HEALTHCARE AND REHAB INC
Entity Type:Organization
Organization Name:HARNOMY HEALTHCARE AND REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHNSON
Authorized Official - Middle Name:UZOMAA
Authorized Official - Last Name:ODUKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-575-7000
Mailing Address - Street 1:4220 GLORIA ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-2253
Mailing Address - Country:US
Mailing Address - Phone:313-575-7000
Mailing Address - Fax:
Practice Address - Street 1:26153 COLGATE ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-3279
Practice Address - Country:US
Practice Address - Phone:313-575-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320600000X, 320800000X, 322D00000X
NONE320600000X
VTNONE320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children