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General NPI Number Information
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NPI Number | 1316288186
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Entity Type | Organization
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Legal Business Name | FIRSTPLAN MATERNAL INFANT SERVICES, LLC
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 48795 MICHAYWE DR
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City | MACOMB
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State | MI
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Zip | 48044-2308
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Country | US
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Telephone | 248-835-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 48795 MICHAYWE DR
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City | MACOMB
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State | MI
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Zip | 48044-2308
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Country | US
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Telephone | 248-835-9700
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JOSEPH EMANUEL HINES
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Credential | LMSW
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Telephone | 248-835-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | 6801087640
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801087640
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 6801087640
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License Number State | MI
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