Provider Demographics
NPI:1891917415
Name:RESIDENT ADVANCEMENT INC
Entity Type:Organization
Organization Name:RESIDENT ADVANCEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLYNEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-750-0382
Mailing Address - Street 1:411 S LEROY STREET
Mailing Address - Street 2:PO BOX 555
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 S LEROY STREET
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430
Practice Address - Country:US
Practice Address - Phone:810-750-0382
Practice Address - Fax:810-750-6712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS250010859320600000X
MIAS760014821320600000X
MIAS250010959320600000X
MIAS760013141320600000X
MIAS250263541320600000X
MIAS440284123320600000X
MIAS760091948320600000X
MIAS250285695320600000X
MIAS250010823320600000X
MIAS250077905320600000X
MIAS250010923320600000X
MIAS440284111320600000X
MIAS730263806320600000X
MIAS250264516320600000X
MIAS730071758320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities