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General NPI Number Information
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NPI Number | 1659823102
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Entity Type | Organization
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Legal Business Name | TRINITY MIHP
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 11/01/2016
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Provider Practice Location Address
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Address Line | 16821 MARK TWAIN ST
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City | DETROIT
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State | MI
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Zip | 48235-4066
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Country | US
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Telephone | 313-999-8724
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Fax |
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Provider Business Mailing Address
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Address Line | 16821 MARK TWAIN ST
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City | DETROIT
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State | MI
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Zip | 48235-4066
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Country | US
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Telephone | 313-999-8724
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS PHINA SMITH
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Credential | LMSW, MPH
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Telephone | 313-304-2353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 6801078286
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License Number State | MI
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