Provider Demographics
NPI:1992728331
Name:SCOTT CORRECTIONL FACILITY
Entity type:Organization
Organization Name:SCOTT CORRECTIONL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAVINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-459-7400
Mailing Address - Street 1:3425 CHEROKEE TRL
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-9498
Mailing Address - Country:US
Mailing Address - Phone:734-481-0239
Mailing Address - Fax:
Practice Address - Street 1:47500 FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2487
Practice Address - Country:US
Practice Address - Phone:734-459-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059562261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health