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General NPI Number Information
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NPI Number | 1184836082
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Entity Type | Organization
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Legal Business Name | KADIMA JEWISH SUPPORT SERVICES FOR ADULTS WITH MENTAL ILLNESS
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 15999 WEST 12 MILE ROAD
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City | SOUTHFIELD
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State | MI
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Zip | 48382
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Country | US
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Telephone | 248-559-8235
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Fax | 248-423-9318
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Provider Business Mailing Address
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Address Line | 15999 W 12 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48076-7159
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Country | US
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Telephone | 248-559-8235
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Fax | 248-423-9318
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JANETTE SHALLAL
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Credential |
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Telephone | 248-559-8235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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