Provider Demographics
NPI:1770859217
Name:CONSUMER ADVANCEMENT
Entity Type:Organization
Organization Name:CONSUMER ADVANCEMENT
Other - Org Name:WOODLAND PARK/FLETCHER HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-449-2473
Mailing Address - Street 1:3209 OLD FARM RD.
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509
Mailing Address - Country:US
Mailing Address - Phone:810-449-2473
Mailing Address - Fax:810-733-0118
Practice Address - Street 1:3209 OLD FARM RD
Practice Address - Street 2:4438 COLBY CT.
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1248
Practice Address - Country:US
Practice Address - Phone:810-449-2473
Practice Address - Fax:810-733-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS250282482320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities