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General NPI Number Information
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NPI Number | 1356707632
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Entity Type | Organization
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Legal Business Name | THE INNER CITY ALANO CLUB FOUNDATION
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Dates
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Enumeration Date | 01/03/2016
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Last Update Date | 01/03/2016
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Provider Practice Location Address
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Address Line | 18600 WYOMING ST
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City | DETROIT
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State | MI
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Zip | 48221-2010
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Country | US
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Telephone | 248-376-6114
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Fax |
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Provider Business Mailing Address
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Address Line | 18600 WYOMING ST
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City | DETROIT
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State | MI
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Zip | 48221-2010
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Country | US
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Telephone | 248-376-6114
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL DEPRIEST
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Credential | CRC
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Telephone | 248-376-6114
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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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