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General NPI Number Information
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NPI Number | 1881907053
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Entity Type | Organization
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Legal Business Name | BAKERS COMMUNITY LLC
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 07/16/2010
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Provider Practice Location Address
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Address Line | 1017 VINSETTA BLVD
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City | ROYAL OAK
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State | MI
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Zip | 48067-1020
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Country | US
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Telephone | 313-622-8201
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Fax |
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Provider Business Mailing Address
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Address Line | 8083 WARD ST
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City | DETROIT
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State | MI
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Zip | 48228-2713
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Country | US
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Telephone | 313-622-8201
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. WILMA KAY BAKER
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Credential |
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Telephone | 313-622-8201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | AS630302466
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License Number State | MI
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