Provider Demographics
NPI:1538768213
Name:THE MADE INSTITUTE
Entity type:Organization
Organization Name:THE MADE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:HOSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUKAIRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-691-7738
Mailing Address - Street 1:503 GARLAND ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2523
Mailing Address - Country:US
Mailing Address - Phone:810-835-8304
Mailing Address - Fax:
Practice Address - Street 1:503 GARLAND ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2523
Practice Address - Country:US
Practice Address - Phone:810-835-8304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty