Provider Demographics
NPI:1104279587
Name:FLATROCK MANOR OF FLINT TOWNSHIP
Entity type:Organization
Organization Name:FLATROCK MANOR OF FLINT TOWNSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:848-459-3831
Mailing Address - Street 1:2360 STONEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5406
Mailing Address - Country:US
Mailing Address - Phone:810-875-9444
Mailing Address - Fax:810-875-9408
Practice Address - Street 1:2360 STONEBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5406
Practice Address - Country:US
Practice Address - Phone:810-875-9444
Practice Address - Fax:810-875-9408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM250369661320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities