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General NPI Number Information
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NPI Number | 1124910492
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Entity Type | Organization
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Legal Business Name | MICHIGAN WARRIORS
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Dates
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Enumeration Date | 07/19/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 8633 SOUTHFIELD FWY
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City | DETROIT
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State | MI
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Zip | 48228-1975
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Country | US
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Telephone | 313-444-4192
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Fax |
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Provider Business Mailing Address
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Address Line | 4508 W WARREN AVE
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City | DETROIT
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State | MI
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Zip | 48210-1464
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TAYLOR LOCKRIDGE
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Credential |
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Telephone | 248-678-4005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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