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General NPI Number Information
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NPI Number | 1144672676
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Entity Type | Organization
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Legal Business Name | GOD'S PRECIOUS TREASURES II
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Dates
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Enumeration Date | 07/08/2016
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 22805 GODDARD RD
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City | TAYLOR
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State | MI
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Zip | 48180-4170
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Country | US
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Telephone | 734-787-8536
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Fax |
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Provider Business Mailing Address
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Address Line | 22805 GODDARD RD
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City | TAYLOR
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State | MI
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Zip | 48180-4170
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Country | US
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Telephone | 734-787-8536
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MS. PATRICIA LYNN MAZYCK-SIMMONS
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Credential | LLMSW
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Telephone | 734-787-8536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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