MEDICARE: THE LANG FOUNDATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251K00000X	Public Health or Welfare Agency
3	251S00000X	Community/Behavioral Health Agency
4	252Y00000X	Early Intervention Provider Agency
5	261Q00000X	Clinic/Center
6	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
7	261QM0855X	Adolescent and Children Mental Health Clinic/Center
8	261QM3000X	Medically Fragile Infants and Children Day Care
9	320800000X	Mental Illness Community Based Residential Treatment Facility
10	3245S0500X	Children's Substance Abuse Rehabilitation Facility
11	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215428586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LANG FOUNDATION

Provider Business Mailing Address
First Line	:	1897 STANLEY BLVD
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-4149
Country	:	US
Telephone Number	:	313-442-6027
Fax Number	:

Provider Business Practice Location Address
First Line	:	1897 STANLEY BLVD
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009
Country	:	US
Telephone Number	:	313-442-6027
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHARLIE COCHRAN
Credential	:
Telephone Number	:	313-329-0724

Provider Enumeration Date	:	05/22/2018
Last Update Date	:	07/17/2018

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Directions to “THE LANG FOUNDATION ” Practice Location

Language	Start Address	Practice Location

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