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General NPI Number Information
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NPI Number | 1558544429
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Entity Type | Organization
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Legal Business Name | POEM HUMANSERVICE DEVELOPMENT CORP.
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 4720 JUNCTION ST
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City | DETROIT
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State | MI
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Zip | 48210-2518
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Country | US
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Telephone | 313-410-1829
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Fax | 313-896-1114
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Provider Business Mailing Address
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Address Line | 3372 18TH ST
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City | DETROIT
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State | MI
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Zip | 48208-2550
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Country | US
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Telephone | 313-896-7238
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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. EMANUEL MORRIS TAYLOR JR.
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Credential | CACM
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Telephone | 313-896-7238
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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 | 1-00079
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License Number State | MI
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