MEDICARE: MOMS AND BABES TOO MSSP AND ISSP, INC

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	251B00000X	Case Management Agency		MI

General Provider Information

NPI Number	:	1427133461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOMS AND BABES TOO MSSP AND ISSP, INC

Provider Business Mailing Address
First Line	:	2051 ROSA PARKS BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-1556
Country	:	US
Telephone Number	:	313-961-8908
Fax Number	:

Provider Business Practice Location Address
First Line	:	2051 ROSA PARKS BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-1556
Country	:	US
Telephone Number	:	313-961-8908
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ALEASIA L HALL
Credential	:
Telephone Number	:	313-961-8908

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	08/22/2020

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