NPIMap

Organization Active NPI

Centria Healthcare LLC

Doing business as Centria Healthcare - Dearborn Center

  • Adolescent and Children Mental Health Clinic/Center
  • Dearborn, MI
National Provider Identifier
1730586710
Registry record updated Dec 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
CENTRIA HEALTHCARE LLC
Doing business as
Centria Healthcare - Dearborn Center
Practice address
19855 Outer Dr
Suite 101
Dearborn, MI 48124-2022
Phone
(248) 299-0030
NPI assigned
Nov 19, 2014
Last updated
Dec 9, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christopher Wilcox
Title
President
Phone
(248) 299-0030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU Primary

Addresses

Primary practice location

19855 Outer Dr
Suite 101
Dearborn, MI 48124-2022

Mailing address

41521 W 11 Mile Rd
Novi, MI 48375-1803
Phone (248) 299-0030

Other names 1

  • Centria Healthcare - Dearborn Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Centria Healthcare6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418083200000",
    "number": "1730586710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41521 W 11 MILE RD",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483751803",
            "telephone_number": "248-299-0030",
            "fax_number": "248-912-1566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19855 OUTER DR",
            "address_2": "SUITE 101",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242022",
            "telephone_number": "248-299-0030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRIA HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-19",
        "last_updated": "2014-12-09",
        "status": "A",
        "authorized_official_last_name": "WILCOX",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-299-0030"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centria Healthcare - Dearborn Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; 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.