Provider Demographics
NPI:1740307909
Name:METRO EAST DRUGTREATMENT CORPORATION
Entity type:Organization
Organization Name:METRO EAST DRUGTREATMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-371-0055
Mailing Address - Street 1:17510 INDIANA ST APT 2
Mailing Address - Street 2:DETROIT
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2483
Mailing Address - Country:US
Mailing Address - Phone:313-371-0055
Mailing Address - Fax:313-371-1409
Practice Address - Street 1:17510 INDIANA ST APT 2
Practice Address - Street 2:DETROIT
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2483
Practice Address - Country:US
Practice Address - Phone:313-371-0055
Practice Address - Fax:313-371-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI821237251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health