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General NPI Number Information
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NPI Number | 1316811474
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Entity Type | Organization
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Legal Business Name | ALL IS WELL MATERNAL INFANT HEALTH PROGRAM
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Dates
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Enumeration Date | 10/01/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 49 TUXEDO ST
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3532
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Country | US
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Telephone | 313-657-3558
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Fax |
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Provider Business Mailing Address
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Address Line | 49 TUXEDO ST
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3532
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Country | US
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Telephone | 313-418-2902
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Fax |
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Authorized Official
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Title or Position | PROGRAM COORDINATOR
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Name | TREVA L GORDON
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Credential | RN
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Telephone | 313-418-2902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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