Provider Demographics
NPI:1720264757
Name:MILESTONE SPECIALIZED CARE,INC.
Entity type:Organization
Organization Name:MILESTONE SPECIALIZED CARE,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGHEE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:313-686-4412
Mailing Address - Street 1:15388 DIXIE
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3637
Mailing Address - Country:US
Mailing Address - Phone:313-686-4412
Mailing Address - Fax:
Practice Address - Street 1:15388 DIXIE ST.
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3637
Practice Address - Country:US
Practice Address - Phone:313-686-4412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YMO8OOX101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty