=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841174240
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELL'S GRACE DOULA & COMMUNITY SERVICES OF DETROIT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2025
-----------------------------------------------------
Last Update Date | 07/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15468 HEYDEN ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48223-1747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-299-0801
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 23176
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48223-0176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-299-0801
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/FOUNDER
-----------------------------------------------------
Name | LA TORIA SHANAY TAGGER
-----------------------------------------------------
Credential | CHW,CD-PIC, CD-L
-----------------------------------------------------
Telephone | 734-299-0801
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------