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General NPI Number Information
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NPI Number | 1467758789
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Entity Type | Organization
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Legal Business Name | MIZPAH GROUP HOME INC
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Dates
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Enumeration Date | 02/03/2011
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Last Update Date | 02/03/2011
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Provider Practice Location Address
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Address Line | 31058 WHEATON 201
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City | NEW HUDSON
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State | MI
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Zip | 48165-9469
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Country | US
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Telephone | 248-796-2639
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Fax |
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Provider Business Mailing Address
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Address Line | 31058 WHEATON 201
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City | NEW HUDSON
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State | MI
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Zip | 48165-9469
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Country | US
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Telephone | 248-796-2639
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALONZO KEVIN MORGAN SR.
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Credential | MA
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Telephone | 248-796-2639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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