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General NPI Number Information
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NPI Number | 1528145844
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Entity Type | Organization
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Legal Business Name | THE CHILDREN'S CENTER OF WAYNE CO., INC.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 79 W ALEXANDRINE ST
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City | DETROIT
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State | MI
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Zip | 48201-2015
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Country | US
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Telephone | 313-831-5535
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Fax | 313-447-2623
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Provider Business Mailing Address
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Address Line | 79 W ALEXANDRINE ST
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City | DETROIT
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State | MI
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Zip | 48201-2015
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Country | US
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Telephone | 313-831-5535
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Fax | 313-447-2623
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Authorized Official
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Title or Position | DIRECTOR - RCM & CLIENT RELATIONS
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Name | TIFFANY LEID
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Credential |
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Telephone | 313-262-0951
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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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Taxonomy #2
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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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 | 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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