Provider Demographics
NPI:1124273826
Name:GERIATRIC PSYCHIATRIC SERVICES PLLC
Entity type:Organization
Organization Name:GERIATRIC PSYCHIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN DIR.
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLEMENTE
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:586-620-8100
Mailing Address - Street 1:39465 W 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1600
Mailing Address - Country:US
Mailing Address - Phone:877-906-9699
Mailing Address - Fax:888-483-0118
Practice Address - Street 1:1 WESTBROOK CORP CTR
Practice Address - Street 2:SUITE 300
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5701
Practice Address - Country:US
Practice Address - Phone:708-375-3075
Practice Address - Fax:866-227-7418
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOTAL CARE SOLUTIONS, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-21
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1515Medicare PIN