Healthcare Provider Details

I. General information

NPI: 1255877668
Provider Name (Legal Business Name): CHURCH OF GOD IN CHRIST SOCIAL SERVICES OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15350 SOUTHFIELD FWY
DETROIT MI
48223-1359
US

IV. Provider business mailing address

15350 SOUTHFIELD FWY
DETROIT MI
48223-1359
US

V. Phone/Fax

Practice location:
  • Phone: 313-398-2238
  • Fax: 313-398-2152
Mailing address:
  • Phone: 313-398-2238
  • Fax: 313-398-2152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PAM PARKER
Title or Position: PROGRAM COORDINATOR
Credential: MSW
Phone: 313-320-6489