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General NPI Number Information
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NPI Number | 1235363698
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Entity Type | Organization
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Legal Business Name | CALDWELL THOMPSON MANOR INTERNATIONAL
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Dates
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Enumeration Date | 05/13/2009
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Last Update Date | 05/13/2009
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Provider Practice Location Address
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Address Line | 8537 VAN DYKE ST
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City | DETROIT
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State | MI
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Zip | 48213-2374
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Country | US
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Telephone | 313-924-9478
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Fax | 313-924-9494
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Provider Business Mailing Address
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Address Line | 23636 CUNNINGHAM AVE
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City | WARREN
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State | MI
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Zip | 48091-3181
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Country | US
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Telephone | 313-924-9478
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Fax | 313-924-9494
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Authorized Official
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Title or Position | MANAGER
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Name | MS. PATRICIA GIBBS
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Credential | LMSW, ACSW
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Telephone | 313-924-9478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801061937
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License Number State | MI
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