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General NPI Number Information
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NPI Number | 1780119214
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Entity Type | Organization
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Legal Business Name | REBIRTH COMMUNITY INCLUSION PROGRAM
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Dates
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Enumeration Date | 04/21/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 16951 MARYLAND ST
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2903
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Country | US
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Telephone | 313-418-5667
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Fax |
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Provider Business Mailing Address
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Address Line | 16951 MARYLAND
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City | DETROIT
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State | MI
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Zip | 48228
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Country | US
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Telephone | 313-418-5667
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Fax |
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Authorized Official
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Title or Position | CHIELF EXECUTIVE OFFICER
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Name | MRS. LINDA TERESA JEFFERSON
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Credential | MA,LLPC,CCS,CAADC
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Telephone | 313-418-5667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | MI
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