Provider Demographics
NPI:1679873798
Name:NORTHWEST DRUG REHABILITATION INC
Entity Type:Organization
Organization Name:NORTHWEST DRUG REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-739-6343
Mailing Address - Street 1:9600 DEXTER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1816
Mailing Address - Country:US
Mailing Address - Phone:313-894-7881
Mailing Address - Fax:313-894-6312
Practice Address - Street 1:9600 DEXTER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1816
Practice Address - Country:US
Practice Address - Phone:313-894-7881
Practice Address - Fax:313-894-6312
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST INDUSTRIAL & MEDICAL SERVICES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045243261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone