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NPI Code Detail

MEDICARE: SALVATION ARMY-HARBOR LIGHT

MEDICARE: SALVATION ARMY-HARBOR LIGHT
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
1251B00000XCase Management Agency
2261QR0800XRecovery Care Clinic/Center
3385H00000XRespite Care
4324500000XSubstance Abuse Rehabilitation Facility4301061866MI

Other Identifiers

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

General Provider Information

NPI Number : 1811094998
Entity Type Code : Organization
Provider Name (Legal Business Name) : SALVATION ARMY-HARBOR LIGHT
Provider Business Mailing Address
First Line : 3737 LAWTON ST
Second Line :
City : DETROIT
State : MI
Zip : 48208-2500
Country : US
Telephone Number : 313-361-6136
Fax Number : 313-361-6210
Provider Business Practice Location Address
First Line : 3737 LAWTON ST
Second Line :
City : DETROIT
State : MI
Zip : 48208-2500
Country : US
Telephone Number : 313-361-6136
Fax Number : 313-361-6210
Authorized Official
Title or Position : QA
Name : MRS. MICHELLE GATES
Credential :
Telephone Number : 313-361-6136
Provider Enumeration Date : 09/20/2006
Last Update Date : 10/10/2024

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Directions to “SALVATION ARMY-HARBOR LIGHT ” Practice Location

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