MEDICARE: EMMANUEL HOUSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		MI

General Provider Information

NPI Number	:	1124453154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMANUEL HOUSE

Provider Business Mailing Address
First Line	:	14750 SAINT MARYS ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48227-1862
Country	:	US
Telephone Number	:	131-339-7237
Fax Number	:	313-838-8606

Provider Business Practice Location Address
First Line	:	14750 SAINT MARYS ST # 48227
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48227-1862
Country	:	US
Telephone Number	:	313-397-2372
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TIMOTHY ARTHUR THOMPSON
Credential	:
Telephone Number	:	313-397-2372

Provider Enumeration Date	:	09/10/2013
Last Update Date	:	11/10/2022

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Directions to “EMMANUEL HOUSE ” Practice Location

Language	Start Address	Practice Location

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