Healthcare Provider Details

I. General information

NPI: 1780465336
Provider Name (Legal Business Name): RONALD MCDONALD HOUSE CHARITIES DETROIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4707 SAINT ANTOINE ST STE 200
DETROIT MI
48201-1427
US

IV. Provider business mailing address

4707 SAINT ANTOINE ST STE 200
DETROIT MI
48201-1427
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5909
  • Fax:
Mailing address:
  • Phone: 313-745-5909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LITOMISKY
Title or Position: CEO
Credential:
Phone: 313-415-1455