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General NPI Number Information
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NPI Number | 1558876987
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Entity Type | Organization
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Legal Business Name | FAMILY HEALTH & WELLNESS COMMUNITY SERVICES LLC
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Dates
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Enumeration Date | 12/07/2017
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Last Update Date | 12/07/2017
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Provider Practice Location Address
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Address Line | 3946 CADIEUX RD
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City | DETROIT
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State | MI
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Zip | 48224-4010
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Country | US
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Telephone | 734-778-4055
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Fax |
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Provider Business Mailing Address
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Address Line | 3946 CADIEUX RD
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City | DETROIT
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State | MI
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Zip | 48224-4010
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Country | US
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Telephone | 734-778-4055
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER/CONSULTANT
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Name | MR. MARIO DENON TATUM
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Credential | MA,LLBSW
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Telephone | 734-778-4055
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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 | 6802087475
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License Number State | MI
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