Provider Demographics
NPI:1104672369
Name:CB WELL LLC
Entity type:Organization
Organization Name:CB WELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-709-9640
Mailing Address - Street 1:2681 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-5990
Mailing Address - Country:US
Mailing Address - Phone:517-215-4900
Mailing Address - Fax:
Practice Address - Street 1:7 W SQUARE LAKE RD STE 111
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0462
Practice Address - Country:US
Practice Address - Phone:248-452-5640
Practice Address - Fax:248-452-5681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty