Healthcare Provider Details

I. General information

NPI: 1770680167
Provider Name (Legal Business Name): SHELTER ASSOCIATION OF WASHTENAW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W HURON ST
ANN ARBOR MI
48103-4204
US

IV. Provider business mailing address

PO BOX 7370
ANN ARBOR MI
48107-7370
US

V. Phone/Fax

Practice location:
  • Phone: 734-662-2829
  • Fax: 734-996-3022
Mailing address:
  • Phone: 734-662-2829
  • Fax: 734-996-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. NANCY WILT
Title or Position: FISCAL DIRECTOR
Credential:
Phone: 734-662-2829