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General NPI Number Information
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NPI Number | 1255877668
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Entity Type | Organization
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Legal Business Name | CHURCH OF GOD IN CHRIST SOCIAL SERVICES OF MICHIGAN
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 15350 SOUTHFIELD FWY
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City | DETROIT
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State | MI
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Zip | 48223-1359
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Country | US
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Telephone | 313-398-2238
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Fax | 313-398-2152
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Provider Business Mailing Address
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Address Line | 15350 SOUTHFIELD FWY
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City | DETROIT
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State | MI
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Zip | 48223-1359
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Country | US
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Telephone | 313-398-2238
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Fax | 313-398-2152
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Authorized Official
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Title or Position | PROGRAM COORDINATOR
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Name | PAM PARKER
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Credential | MSW
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Telephone | 313-320-6489
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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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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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