Provider Demographics
NPI:1417969163
Name:BIOSERENITY DT INC.
Entity Type:Organization
Organization Name:BIOSERENITY DT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-532-3757
Mailing Address - Street 1:99 ROSEWOOD DR STE 245
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-4537
Mailing Address - Country:US
Mailing Address - Phone:978-536-7400
Mailing Address - Fax:978-535-9778
Practice Address - Street 1:32100 TELEGRAPH RD
Practice Address - Street 2:SUITE 145
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025
Practice Address - Country:US
Practice Address - Phone:248-281-0151
Practice Address - Fax:248-281-0156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N69430OtherPREFERRED HEALTHPLAN
MI0N69430OtherHAP
MI004251OtherMIDWEST HEALTH PLAN
MI0N69430OtherPREFERRED HEALTHPLAN