Provider Demographics
NPI:1750826236
Name:MAINSTREAM MEDIA GROUP
Entity Type:Organization
Organization Name:MAINSTREAM MEDIA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:THRASHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-943-4107
Mailing Address - Street 1:5000 TOWN CTR
Mailing Address - Street 2:2405
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5000 TOWN CTR
Practice Address - Street 2:2405
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1110
Practice Address - Country:US
Practice Address - Phone:248-943-4107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No252Y00000XAgenciesEarly Intervention Provider Agency
No347C00000XTransportation ServicesPrivate Vehicle