Healthcare Provider Details

I. General information

NPI: 1538917851
Provider Name (Legal Business Name): CHILD AND FAMILY SERVICES NORTHEAST MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 US HIGHWAY 23 N
ALPENA MI
49707-1262
US

IV. Provider business mailing address

1044 US HIGHWAY 23 N
ALPENA MI
49707-1262
US

V. Phone/Fax

Practice location:
  • Phone: 198-935-6456
  • Fax:
Mailing address:
  • Phone: 989-255-3317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANIE ANN DETTLOFF
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 989-255-3317