Provider Demographics
NPI:1720268063
Name:ROBBIE'S PLACE
Entity Type:Organization
Organization Name:ROBBIE'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VERRITA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:FOUNTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-883-4515
Mailing Address - Street 1:98 RHODE ISLAND ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3359
Mailing Address - Country:US
Mailing Address - Phone:313-883-4515
Mailing Address - Fax:313-664-0224
Practice Address - Street 1:4038 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-2419
Practice Address - Country:US
Practice Address - Phone:313-894-7350
Practice Address - Fax:313-894-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-04
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness