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General NPI Number Information
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NPI Number | 1639587199
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Entity Type | Organization
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Legal Business Name | GREAT FUTURES MATERNAL INFANT HEALTH PROGRAM, LLC
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 15892 ORCHARD LN
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City | ROSEVILLE
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State | MI
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Zip | 48066-5215
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Country | US
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Telephone | 313-737-0018
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Fax |
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Provider Business Mailing Address
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Address Line | 15892 ORCHARD LN
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City | ROSEVILLE
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State | MI
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Zip | 48066-5215
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Country | US
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Telephone | 313-737-0018
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MS. LASHAWN MYERS
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Credential | MSW
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Telephone | 313-737-0018
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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 | 6802080544
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6802080544
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 6802080544
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License Number State | MI
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