Healthcare Provider Details

I. General information

NPI: 1619796398
Provider Name (Legal Business Name): NEIGHBORHOOD SERVICE ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3426 MACK AVE
DETROIT MI
48207-2315
US

IV. Provider business mailing address

882 OAKMAN BLVD STE C
DETROIT MI
48238-4019
US

V. Phone/Fax

Practice location:
  • Phone: 888-360-9355
  • Fax:
Mailing address:
  • Phone: 313-305-0294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JULIE HERZIG
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 313-961-4890