Healthcare Provider Details

I. General information

NPI: 1619285533
Provider Name (Legal Business Name): FAMILY SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 HARPER AVE
DETROIT MI
48213-3364
US

IV. Provider business mailing address

10900 HARPER AVE
DETROIT MI
48213-3364
US

V. Phone/Fax

Practice location:
  • Phone: 313-579-5989
  • Fax:
Mailing address:
  • Phone: 313-579-5989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number6801081677
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number6801081677
License Number StateMI

VIII. Authorized Official

Name: MS. VIRDELL THOMAS
Title or Position: DIRECTOR
Credential: LMSW
Phone: 313-579-5989