Healthcare Provider Details

I. General information

NPI: 1043759442
Provider Name (Legal Business Name): JENNIFER CURTIS N/A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 01/18/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 RUSSELL ST
DETROIT MI
48207-4825
US

IV. Provider business mailing address

2925 RUSSELL ST
DETROIT MI
48207-4825
US

V. Phone/Fax

Practice location:
  • Phone: 313-396-5000
  • Fax:
Mailing address:
  • Phone: 313-396-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number464090206
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number464090206
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: