Healthcare Provider Details

I. General information

NPI: 1427133461
Provider Name (Legal Business Name): MOMS AND BABES TOO MSSP AND ISSP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 ROSA PARKS BLVD
DETROIT MI
48216-1556
US

IV. Provider business mailing address

2051 ROSA PARKS BLVD
DETROIT MI
48216-1556
US

V. Phone/Fax

Practice location:
  • Phone: 313-961-8908
  • Fax:
Mailing address:
  • Phone: 313-961-8908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: ALEASIA L HALL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 313-961-8908