Healthcare Provider Details

I. General information

NPI: 1831384338
Provider Name (Legal Business Name): COMMUNITY WORK OPPORTUNITIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2007
Last Update Date: 07/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 N LILLEY RD SUITE 108
CANTON MI
48187-3776
US

IV. Provider business mailing address

32231 SCHOOLCRAFT RD SUITE 200
LIVONIA MI
48150-4312
US

V. Phone/Fax

Practice location:
  • Phone: 734-981-3709
  • Fax: 734-981-5384
Mailing address:
  • Phone: 734-458-8140
  • Fax: 734-458-7935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN M BOISVENU X
Title or Position: PRESIDENT
Credential:
Phone: 734-458-8140