Healthcare Provider Details

I. General information

NPI: 1164842829
Provider Name (Legal Business Name): BABY STEPS MATERNAL AND INFANT HEALTH PROGRAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6318 DEXTER ST
ROMULUS MI
48174-1832
US

IV. Provider business mailing address

PO BOX 3725
SOUTHFIELD MI
48037-3725
US

V. Phone/Fax

Practice location:
  • Phone: 248-403-4435
  • Fax: 248-352-3907
Mailing address:
  • Phone: 248-403-4435
  • Fax: 248-352-3907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMI

VIII. Authorized Official

Name: ERICA KELLEY
Title or Position: OWNER
Credential: LPC,CRC,LBSW
Phone: 248-403-4435