Healthcare Provider Details

I. General information

NPI: 1386832491
Provider Name (Legal Business Name): TGW MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8537 VAN DYKE ST
DETROIT MI
48213-2374
US

IV. Provider business mailing address

8537 VAN DYKE ST
DETROIT MI
48213-2374
US

V. Phone/Fax

Practice location:
  • Phone: 313-924-9478
  • Fax:
Mailing address:
  • Phone: 313-924-9478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801061937
License Number StateMI

VIII. Authorized Official

Name: PATRICIA GIBBS
Title or Position: MANAGER
Credential:
Phone: 313-924-9478