MEDICARE: GIVING GUIDANCE IN THE GENERATIONAL GAP

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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1922356542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIVING GUIDANCE IN THE GENERATIONAL GAP

Provider Business Mailing Address
First Line	:	24225 W 9 MILE RD
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3962
Country	:	US
Telephone Number	:	248-796-2073
Fax Number	:

Provider Business Practice Location Address
First Line	:	24225 W 9 MILE RD
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3962
Country	:	US
Telephone Number	:	248-796-2073
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JEANETTA RILEY
Credential	:
Telephone Number	:	313-242-7688

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	08/29/2012

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