Provider Demographics
NPI:1033950787
Name:PAULINE'S PLACE LLC
Entity type:Organization
Organization Name:PAULINE'S PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-646-9762
Mailing Address - Street 1:20253 SAINT MARYS ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2134
Mailing Address - Country:US
Mailing Address - Phone:313-646-9762
Mailing Address - Fax:313-646-9762
Practice Address - Street 1:20253 SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2134
Practice Address - Country:US
Practice Address - Phone:313-646-9762
Practice Address - Fax:313-646-9762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency