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General NPI Number Information
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NPI Number | 1669466611
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Entity Type | Organization
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Legal Business Name | MOTHER'S FRIEND MATERNAL/INFANT SUPPORT SERVICES
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16250 NORTHLAND DR
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5208
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Country | US
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Telephone | 248-559-5722
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Fax | 248-559-5622
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Provider Business Mailing Address
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Address Line | 14401 GREENVIEW RD
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City | DETROIT
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State | MI
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Zip | 48223-2913
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Country | US
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Telephone | 248-559-5722
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Fax | 248-559-5622
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Authorized Official
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Title or Position | CEO
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Name | MRS. DASHUNA RELIEU JOHNSON
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Credential | RN
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Telephone | 248-559-5722
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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 |
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License Number State | MI
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