Healthcare Provider Details

I. General information

NPI: 1659428167
Provider Name (Legal Business Name): METHODIST CHILDREN'S HOME SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26645 W 6 MILE RD
REDFORD MI
48240-2319
US

IV. Provider business mailing address

26645 W 6 MILE RD
REDFORD MI
48240-2319
US

V. Phone/Fax

Practice location:
  • Phone: 313-531-4060
  • Fax: 313-531-1040
Mailing address:
  • Phone: 313-153-1406
  • Fax: 313-531-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberC1820201294
License Number StateMI

VIII. Authorized Official

Name: MR. HENRY M. KASSEN
Title or Position: ASST. EXEC. DIRECTOR - FINANCE
Credential:
Phone: 313-531-9970