Provider Demographics
NPI:1336369099
Name:SILVERSPOON, INC
Entity Type:Organization
Organization Name:SILVERSPOON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-663-0038
Mailing Address - Street 1:31700 W 13 MILE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2171
Mailing Address - Country:US
Mailing Address - Phone:248-702-6040
Mailing Address - Fax:248-702-6041
Practice Address - Street 1:31700 W 13 MILE RD STE 201
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2171
Practice Address - Country:US
Practice Address - Phone:248-702-6040
Practice Address - Fax:248-702-6041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4947505Medicaid