Mr. Harold Alphonso Rudolph - Detroit, MI

Mr. Harold Alphonso Rudolph

Mental Illness Community Based Residential Treatment Facility in Detroit, Michigan

NPI 1346588076

Harold Alphonso Rudolph is a Mental Illness Community Based Residential Treatment Facility based in Detroit, MI. Harold Alphonso Rudolph practices in Detroit, MI. The NPI Number for Harold Alphonso Rudolph is 1346588076 and holds a License No. 820174 (Michigan).

The current practice location address for Harold Alphonso Rudolph is 1852 W Grand Blvd, Detroit, MI and can be reached out via phone at 313-894-8444 and via fax at 313-894-5542.

Location: 1852 W Grand Blvd, Detroit, MI, 48208-1006

NPI Number

1346588076

Provider Name

Harold Alphonso Rudolph

Credential

Provider Entity Type

Individual

Gender

Male

Address

1852 W Grand Blvd, Detroit, MI, 48208-1006

Phone Number

313-894-8444

Fax Number

313-894-5542

Provider Enumeration Date

01/31/2013

Last Update Date

03/09/2024

Identifier	Type	State	Issuer
381917278	05	MI

Address

1852 W Grand Blvd

City

Detroit

State

Michigan

Zip

48208-1006

Phone Number

313-894-8444

Fax Number

313-894-5542

Address

1852 W Grand Blvd

City

Detroit

State

Michigan

Zip

48208-1006

Phone Number

313-894-8444

Fax Number

313-894-5542

Type

Residential Treatment Facilities

Classification

Community Based Residential Treatment Facility, Mental Illness

Speciality

Taxonomy

320800000X

License No.

820174 (Michigan)

Definition

A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

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