Provider Demographics
NPI:1740653641
Name:ANN ARBOR TREATMENT SERVICES, LLC
Entity type:Organization
Organization Name:ANN ARBOR TREATMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-281-5303
Mailing Address - Street 1:3121 SMALLMAN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201-1425
Mailing Address - Country:US
Mailing Address - Phone:412-281-5303
Mailing Address - Fax:412-281-5304
Practice Address - Street 1:4673 WASHTENAW AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108
Practice Address - Country:US
Practice Address - Phone:734-544-1523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE TREATMENT CENTERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL969829261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIL969829OtherSTATE OF MICHIGAN LICENSE