Healthcare Provider Details

I. General information

NPI: 1407079882
Provider Name (Legal Business Name): POSITIVE IMAGES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 E GRAND BLVD
DETROIT MI
48207-2526
US

IV. Provider business mailing address

13340 E WARREN AVE
DETROIT MI
48215-2112
US

V. Phone/Fax

Practice location:
  • Phone: 313-822-6940
  • Fax: 313-822-6946
Mailing address:
  • Phone: 313-822-6940
  • Fax: 313-822-6946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number821843
License Number StateMI

VIII. Authorized Official

Name: MS. MAISHA KENYATTA
Title or Position: EXECUTIVE DIRECTOR
Credential: LMSW
Phone: 313-822-6940