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NPI Code Detail

MEDICARE: MICHIGAN WARRIORS

MEDICARE: MICHIGAN WARRIORS
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
1251S00000XCommunity/Behavioral Health Agency
2172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1700767308
Entity Type Code : Organization
Provider Name (Legal Business Name) : MICHIGAN WARRIORS
Provider Business Mailing Address
First Line : 22430 GRATIOT AVE UNIT 227
Second Line :
City : EASTPOINTE
State : MI
Zip : 48021-7011
Country : US
Telephone Number : 313-804-8635
Fax Number : 517-515-7469
Provider Business Practice Location Address
First Line : 8633 SOUTHFIELD FWY
Second Line :
City : DETROIT
State : MI
Zip : 48228-1975
Country : US
Telephone Number : 313-804-8635
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : TAYLOR LOCKRIDGE
Credential : CCHW
Telephone Number : 313-804-8635
Provider Enumeration Date : 09/10/2025
Last Update Date : 03/17/2026

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Directions to “MICHIGAN WARRIORS ” Practice Location

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