Inner Man Wellness and Support Services

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

INNER MAN WELLNESS AND SUPPORT SERVICES

Practice address

4890 Ballantrae Rd
Bloomfield, MI 48301-1000

Phone

(248) 802-2712

NPI assigned

Mar 21, 2019

Organization subpart

No

Name

Roderick GillisonNPI 1205576832

Title

Executive Director

Phone

(248) 802-2712

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Roderick Gillison

  • Addiction (Substance Use Disorder) Counselor
  • Southgate, MI
  • NPI 1205576832
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 21, 2019.

{
    "created_epoch": "1553126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553126400000",
    "number": "1669932109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4890 BALLANTRAE RD",
            "city": "BLOOMFIELD",
            "state": "MI",
            "postal_code": "483011000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4890 BALLANTRAE RD",
            "city": "BLOOMFIELD",
            "state": "MI",
            "postal_code": "483011000",
            "telephone_number": "248-802-2712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNER MAN WELLNESS AND SUPPORT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-21",
        "last_updated": "2019-03-21",
        "status": "A",
        "authorized_official_last_name": "GILLISON",
        "authorized_official_first_name": "RODERICK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "248-802-2712"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miriam Halprin, LMSW
• Danielle Harfoot, PA-C
• Daniel Herman, DC
• Joy Hopson
• Mohammed Ibrahim, PHARM.D
• International Medical Clinic PLLC
• James S. Brooks, MD, PLLC
• Joyful Journey'S Living and Care LCC
• Kayla Kane, FNP-C
• Ramesh Chandra Kilaru, M.D

• All providers in Bloomfield, MI
• Substance Abuse Rehabilitation Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.