MEDICARE: BROADENS HELPING HANDS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101Y00000X	Counselor	MI
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	MI
3	101YP2500X	Professional Counselor	MI
4	171M00000X	Case Manager/Care Coordinator	MI
5	172V00000X	Community Health Worker	MI

General Provider Information

NPI Number	:	1871881268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROADENS HELPING HANDS

Provider Business Mailing Address
First Line	:	PO BOX 66
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-0066
Country	:	US
Telephone Number	:	313-421-9901
Fax Number	:	313-383-3689

Provider Business Practice Location Address
First Line	:	2236 HUBBELL ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48128-1395
Country	:	US
Telephone Number	:	313-421-9901
Fax Number	:	313-383-3689

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DEIDRA JOYCE BROADEN
Credential	:
Telephone Number	:	313-421-9901

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	07/19/2011

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Directions to “BROADENS HELPING HANDS ” Practice Location

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