Provider Demographics
NPI:1245426915
Name:DAS II RESIDENTIAL CARE
Entity Type:Organization
Organization Name:DAS II RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:313-826-1593
Mailing Address - Street 1:13301 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48212-2545
Mailing Address - Country:US
Mailing Address - Phone:313-826-1593
Mailing Address - Fax:313-826-1595
Practice Address - Street 1:13301 MOUND RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-2545
Practice Address - Country:US
Practice Address - Phone:313-826-1593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI822784324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility