Provider Demographics
NPI:1942484647
Name:EDM TREATMENT CENTER
Entity Type:Organization
Organization Name:EDM TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:SHIA
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-401-1440
Mailing Address - Street 1:3605 DAVENPORT AVE
Mailing Address - Street 2:STE. 205
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3310
Mailing Address - Country:US
Mailing Address - Phone:989-401-1440
Mailing Address - Fax:866-466-7892
Practice Address - Street 1:3605 DAVENPORT AVE
Practice Address - Street 2:STE 205
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3310
Practice Address - Country:US
Practice Address - Phone:989-401-1440
Practice Address - Fax:866-466-7892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health