Healthcare Provider Details

I. General information

NPI: 1003665050
Provider Name (Legal Business Name): KALASHO EDUCATION AND YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29900 LORRAINE AVE
WARREN MI
48093-5266
US

IV. Provider business mailing address

29900 LORRAINE AVE
WARREN MI
48093-5266
US

V. Phone/Fax

Practice location:
  • Phone: 586-393-1570
  • Fax:
Mailing address:
  • Phone: 586-393-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: NADINE KHALIL
Title or Position: OWNER
Credential:
Phone: 248-866-0351