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General NPI Number Information
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NPI Number | 1255665436
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Entity Type | Organization
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Legal Business Name | MAKA SIL & GROUP HOME, INC
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 07/10/2015
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Provider Practice Location Address
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Address Line | 24123 GREENFIELD RD STE 307
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3125
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Country | US
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Telephone | 248-595-8108
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Fax | 248-595-8237
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Provider Business Mailing Address
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Address Line | 24123 GREENFIELD RD STE 307
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3125
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Country | US
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Telephone | 248-595-8108
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Fax | 248-595-8237
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Authorized Official
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Title or Position | ASSISTANT DIRECTOR
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Name | MR. RAYMOND KYLE WILLIAMS JR.
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Credential |
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Telephone | 313-347-6334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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