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General NPI Number Information
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NPI Number | 1104100411
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Entity Type | Organization
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Legal Business Name | KATHY'S MATERNAL INFANT HEALTH PROGRAM
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 18446 WESTHAVEN AVE
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4119
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Country | US
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Telephone | 248-320-6992
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Fax | 866-396-4055
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Provider Business Mailing Address
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Address Line | 18446 WESTHAVEN AVE
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4119
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Country | US
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Telephone | 248-320-6992
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Fax | 866-396-4055
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KATHERINE ANITA THOMPSON
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Credential | LLBSW
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Telephone | 248-320-6992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 6802085964
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 6802085964
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License Number State | MI
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