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General NPI Number Information
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NPI Number | 1780284190
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Entity Type | Organization
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Legal Business Name | CALEB'S KIDS
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 2470 COLLINGWOOD ST STE 206
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City | DETROIT
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State | MI
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Zip | 48206-1500
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Country | US
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Telephone | 313-437-1609
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Fax |
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Provider Business Mailing Address
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Address Line | 22200 W 11 MILE RD UNIT 3663
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City | SOUTHFIELD
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State | MI
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Zip | 48037-7107
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Country | US
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Telephone | 313-437-1609
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KIESHA JACKSON
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Credential |
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Telephone | 313-437-1609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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