Provider Demographics
NPI:1831394451
Name:J.A.DITTY AND ASSOCIATES
Entity type:Organization
Organization Name:J.A.DITTY AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:J
Authorized Official - Last Name:YANOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-680-0080
Mailing Address - Street 1:1709 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2512
Mailing Address - Country:US
Mailing Address - Phone:248-680-0080
Mailing Address - Fax:248-680-1472
Practice Address - Street 1:1709 JOHN R RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2512
Practice Address - Country:US
Practice Address - Phone:248-680-0080
Practice Address - Fax:248-680-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities