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General NPI Number Information
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NPI Number | 1265705578
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Entity Type | Organization
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Legal Business Name | BEYOND BOUNDARIES
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 5706 S WAYNE RD
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City | WAYNE
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State | MI
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Zip | 48184-2913
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Country | US
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Telephone | 734-355-2624
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Fax | 313-331-1912
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Provider Business Mailing Address
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Address Line | 11274 MOORE ST.
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City | ROMULUS
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State | MI
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Zip | 48174
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Country | US
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Telephone | 734-355-2624
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Fax | 313-331-1912
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Authorized Official
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Title or Position | CEO
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Name | MS. GLORIA DEAN HAMILTON
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Credential |
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Telephone | 734-355-2624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | AS820313478
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License Number State | MI
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