Provider Demographics
NPI:1124837885
Name:ROBERTSON-STREET, RENITA
Entity type:Individual
Prefix:MS
First Name:RENITA
Middle Name:
Last Name:ROBERTSON-STREET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19454 STAHELIN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2155
Mailing Address - Country:US
Mailing Address - Phone:248-346-1263
Mailing Address - Fax:
Practice Address - Street 1:19454 STAHELIN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-2155
Practice Address - Country:US
Practice Address - Phone:248-346-1263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No172V00000XOther Service ProvidersCommunity Health Worker
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care
No332U00000XSuppliersHome Delivered Meals
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child