Provider Demographics
NPI:1861034225
Name:NORTHEND VILLAGE NON-PROFIT
Entity type:Organization
Organization Name:NORTHEND VILLAGE NON-PROFIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-363-7018
Mailing Address - Street 1:22745 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-1725
Mailing Address - Country:US
Mailing Address - Phone:313-363-7018
Mailing Address - Fax:248-608-8592
Practice Address - Street 1:8904 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1821
Practice Address - Country:US
Practice Address - Phone:313-363-7018
Practice Address - Fax:248-608-8592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care