Healthcare Provider Details

I. General information

NPI: 1316811474
Provider Name (Legal Business Name): ALL IS WELL MATERNAL INFANT HEALTH PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 TUXEDO ST
HIGHLAND PARK MI
48203-3532
US

IV. Provider business mailing address

49 TUXEDO ST
HIGHLAND PARK MI
48203-3532
US

V. Phone/Fax

Practice location:
  • Phone: 313-657-3558
  • Fax:
Mailing address:
  • Phone: 313-418-2902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: TREVA L GORDON
Title or Position: PROGRAM COORDINATOR
Credential: RN
Phone: 313-418-2902