Provider Demographics
NPI:1437603578
Name:CENTRIA HEALTHCARE
Entity Type:Organization
Organization Name:CENTRIA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ABA BEHAVIOR TECH
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:MARQUINTA
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-394-7091
Mailing Address - Street 1:2848 CLEMENT ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-3028
Mailing Address - Country:US
Mailing Address - Phone:810-394-7091
Mailing Address - Fax:
Practice Address - Street 1:2848 CLEMENT ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-3028
Practice Address - Country:US
Practice Address - Phone:810-394-7091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-06
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management