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NPI Code Detail

MEDICARE: MISIDE (SOUTHWEST SOLUTIONS)

MEDICARE: MISIDE (SOUTHWEST SOLUTIONS)
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1841141678
Entity Type Code : Organization
Provider Name (Legal Business Name) : MISIDE (SOUTHWEST SOLUTIONS)
Provider Business Mailing Address
First Line : 19750 BURT RD
Second Line :
City : DETROIT
State : MI
Zip : 48219-2078
Country : US
Telephone Number : 313-497-4984
Fax Number :
Provider Business Practice Location Address
First Line : 19750 BURT RD
Second Line :
City : DETROIT
State : MI
Zip : 48219-2078
Country : US
Telephone Number : 313-497-4984
Fax Number :
Authorized Official
Title or Position : OUTPATIENT CLINICIAN/ CASE MANAGER
Name : INDIA VIANCA OWEN
Credential : LLMSW
Telephone Number : 313-516-3196
Provider Enumeration Date : 02/06/2026
Last Update Date : 02/06/2026

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1225431109 — RODERICK MILLS
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1518361609 — TAMMY GREEN BSW, MHRM
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1225436819 — KASSINDRA BOYDEN LMSW
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Directions to “MISIDE (SOUTHWEST SOLUTIONS) ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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