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General NPI Number Information
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NPI Number | 1780996926
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Entity Type | Organization
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Legal Business Name | KOUROUMA SERVICES LLC
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Dates
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Enumeration Date | 07/03/2010
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 13560 E MCNICHOLS RD
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City | DETROIT
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State | MI
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Zip | 48205-3426
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Country | US
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Telephone | 313-402-7812
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8235
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City | EASTPOINTE
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State | MI
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Zip | 48021-8235
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Country | US
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Telephone | 313-402-7812
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CHANTELLE MORRISON-KOUROUMA
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Credential | RN, M.ED
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Telephone | 313-402-7812
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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 | 4704258152
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 4704258152
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 4704258152
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 4704258152
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License Number State | MI
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