Healthcare Provider Details

I. General information

NPI: 1952495384
Provider Name (Legal Business Name): KEY DEVELOPMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8619 WEST GRAND RIVER SUITE K
BRIGHTON MI
48116
US

IV. Provider business mailing address

2708 EAST GRAND RIVER #113
HOWELL MI
48843
US

V. Phone/Fax

Practice location:
  • Phone: 810-220-8192
  • Fax:
Mailing address:
  • Phone: 517-545-5890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number470057
License Number StateMI

VIII. Authorized Official

Name: MS. ANNE MARIE KING-HUDSON
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, CACII
Phone: 810-220-8192