Provider Demographics
NPI:1346415858
Name:SELECT CARE PLLC
Entity Type:Organization
Organization Name:SELECT CARE PLLC
Other - Org Name:WALTER P REUTHER PSYCHIATRIC HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIREEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-330-2282
Mailing Address - Street 1:7059 TIMBERVIEW TRAIL
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-788-9272
Mailing Address - Fax:248-788-9272
Practice Address - Street 1:7059 TIMBERVIEW TRL
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3353
Practice Address - Country:US
Practice Address - Phone:248-788-9272
Practice Address - Fax:248-788-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062399208D00000X, 281P00000X, 282N00000X, 283Q00000X, 310400000X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283Q00000XHospitalsPsychiatric Hospital
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No281P00000XHospitalsChronic Disease Hospital
No282N00000XHospitalsGeneral Acute Care Hospital
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG66765Medicare UPIN