Provider Demographics
NPI:1770021537
Name:ABUNDANT COMMUNITY RECOVERY SERVICES
Entity type:Organization
Organization Name:ABUNDANT COMMUNITY RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,CADC
Authorized Official - Phone:313-924-8284
Mailing Address - Street 1:20102 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1712
Mailing Address - Country:US
Mailing Address - Phone:313-924-8284
Mailing Address - Fax:
Practice Address - Street 1:1670 OAKMAN BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-2792
Practice Address - Country:US
Practice Address - Phone:313-924-8285
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 Licenses
StateLicense IDTaxonomies
MISA0823182101YA0400X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty