Healthcare Provider Details

I. General information

NPI: 1346806940
Provider Name (Legal Business Name): EMMANUEL HOUSE 1&2 INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14655 GRATIOT AVE
DETROIT MI
48205-1925
US

IV. Provider business mailing address

18425 HICKORY ST
DETROIT MI
48205-2707
US

V. Phone/Fax

Practice location:
  • Phone: 313-729-4547
  • Fax:
Mailing address:
  • Phone: 313-729-4547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BLANCHE RENEE FOSTER
Title or Position: CEO
Credential:
Phone: 313-729-4547