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General NPI Number Information
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NPI Number | 1619262631
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Entity Type | Organization
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Legal Business Name | ALLEN FOSTER REDEEMER OUTREACH
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 06/17/2011
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Provider Practice Location Address
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Address Line | 18478 WYOMING AVE
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City | DETROIT
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State | MI
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Zip | 48221
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Country | US
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Telephone | 313-850-7818
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Fax |
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Provider Business Mailing Address
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Address Line | 18478 WYOMING ST
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City | DETROIT
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State | MI
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Zip | 48221-2034
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Country | US
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Telephone | 313-850-7818
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Fax | 313-255-4028
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Authorized Official
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Title or Position | CHEIF EXECUTIVE OFFICER
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Name | MRS. EVON NICOLE ALLEN
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Credential | LLMSW
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Telephone | 313-850-7818
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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 | 6801087359
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License Number State | MI
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