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General NPI Number Information
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NPI Number | 1558758862
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Entity Type | Organization
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Legal Business Name | OUR SPECIAL GEMS
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 04/24/2015
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Provider Practice Location Address
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Address Line | 9116 GRAYFIELD
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City | REDFORD
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State | MI
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Zip | 48239-1132
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Country | US
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Telephone | 313-207-6571
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Fax |
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Provider Business Mailing Address
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Address Line | 9116 GRAYFIELD
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City | REDFORD
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State | MI
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Zip | 48239-1132
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Country | US
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Telephone | 313-207-6571
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | LENDEN SAVANAH FAVORS
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Credential |
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Telephone | 313-207-6571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 171M00000X
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License Number State | MI
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