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General NPI Number Information
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NPI Number | 1881004430
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Entity Type | Organization
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Legal Business Name | BABY.COM MHIP
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 05/05/2014
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Provider Practice Location Address
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Address Line | 2325 S VENOY RD
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City | WESTLAND
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State | MI
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Zip | 48186-4662
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Country | US
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Telephone | 734-827-5337
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Fax |
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Provider Business Mailing Address
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Address Line | 2325 S VENOY RD
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City | WESTLAND
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State | MI
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Zip | 48186-4662
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Country | US
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Telephone | 734-827-5337
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CAROLYN DENEEN LIDDELL
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Credential | MSW
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Telephone | 734-837-5337
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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 | 6801079183
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License Number State | MI
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