Provider Demographics
NPI:1700324548
Name:BIOMED BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:BIOMED BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:FELICIA
Authorized Official - Last Name:HARTSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-417-0929
Mailing Address - Street 1:727 W GRAND BLVD
Mailing Address - Street 2:APT. 150
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48216-2119
Mailing Address - Country:US
Mailing Address - Phone:248-417-0929
Mailing Address - Fax:
Practice Address - Street 1:269 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3364
Practice Address - Country:US
Practice Address - Phone:248-706-5041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization