Active NPI
Brenda White
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Warren, MI
National Provider Identifier
1295258010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- License
- AF500286756
- Practice address
- 21180 Gentner St
Warren, MI 48089-3437 - Phone
- (586) 774-9559
- NPI assigned
- Jul 24, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | AF500286756 | MI | Primary |
Addresses
Primary practice location
21180 Gentner St
Warren, MI 48089-3437
Mailing address
21180 Gentner St
Warren, MI 48089-3437
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AF500286756 | MI | MD | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500854400000",
"number": "1295258010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21180 GENTNER ST",
"city": "WARREN",
"state": "MI",
"postal_code": "480893437"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21180 GENTNER ST",
"city": "WARREN",
"state": "MI",
"postal_code": "480893437",
"telephone_number": "586-774-9559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "BRENDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-07-24",
"last_updated": "2017-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "320900000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": "MI",
"license": "AF500286756",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warren, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.