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General NPI Number Information
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NPI Number | 1841435294
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Entity Type | Organization
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Legal Business Name | JUDAH TRANSITIONAL & RECOVERY HOME
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Dates
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Enumeration Date | 12/12/2008
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 20955 W 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48219-1904
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Country | US
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Telephone | 313-535-0903
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Fax | 313-535-0903
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Provider Business Mailing Address
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Address Line | 20955 W 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48219-1904
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Country | US
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Telephone | 313-535-0903
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Fax | 313-535-0903
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ALONZO JOHNSON
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Credential | ORDAINED MINISTER
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Telephone | 313-982-2678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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