Provider Demographics
NPI:1447619697
Name:GREAT SCOTT HOMES INC
Entity Type:Organization
Organization Name:GREAT SCOTT HOMES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEDESTA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWABUEZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-910-9560
Mailing Address - Street 1:PO BOX 4207
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-4207
Mailing Address - Country:US
Mailing Address - Phone:248-910-9560
Mailing Address - Fax:248-799-9210
Practice Address - Street 1:3202 LESLIE ST
Practice Address - Street 2:DETROIT
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-3308
Practice Address - Country:US
Practice Address - Phone:248-910-9560
Practice Address - Fax:248-799-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 261QA0600X
MIAF820307845320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty