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General NPI Number Information
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NPI Number | 1821418435
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Entity Type | Organization
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Legal Business Name | MINDS OF MOMS
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 22927 LAKESHORE DR
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-2716
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Country | US
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Telephone | 313-613-0485
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5746
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City | DETROIT
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State | MI
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Zip | 48205-0746
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RN
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Name | TAMMIE KING
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Credential |
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Telephone | 313-613-0485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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