Provider Demographics
NPI:1770980112
Name:ANNEDON BRIGHTON LLC
Entity type:Organization
Organization Name:ANNEDON BRIGHTON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-403-9776
Mailing Address - Street 1:10031 SPENCER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-3806
Mailing Address - Country:US
Mailing Address - Phone:810-344-8082
Mailing Address - Fax:810-222-0279
Practice Address - Street 1:10031 SPENCER RD
Practice Address - Street 2:SUITE A
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-3806
Practice Address - Country:US
Practice Address - Phone:810-344-8082
Practice Address - Fax:810-222-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-02-1007103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D70431OtherBCBSM