Healthcare Provider Details

I. General information

NPI: 1407939010
Provider Name (Legal Business Name): CHILDRENS'S HOME OF DETROIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 COOK RD
GROSSE POINTE WOODS MI
48236-2713
US

IV. Provider business mailing address

900 COOK RD
GROSSE POINTE WOODS MI
48236-2713
US

V. Phone/Fax

Practice location:
  • Phone: 313-886-0800
  • Fax:
Mailing address:
  • Phone: 313-886-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberC1500201051
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberC1820201056
License Number StateMI

VIII. Authorized Official

Name: MRS. SALLY SAVAGE
Title or Position: CHIEF FINANCIAL OFFICIER
Credential: CPA
Phone: 313-886-0800