Provider Demographics
NPI: | 1982923371 |
---|---|
Name: | MOTIVATIONAL FAMILY & FRIENDS CIRCLE |
Entity type: | Organization |
Organization Name: | MOTIVATIONAL FAMILY & FRIENDS CIRCLE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | SYLVIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ROLAND |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 313-673-1338 |
Mailing Address - Street 1: | 13011 W MCNICHOLS RD |
Mailing Address - Street 2: | |
Mailing Address - City: | DETROIT |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48235-4116 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 13011 W MCNICHOLS RD |
Practice Address - Street 2: | |
Practice Address - City: | DETROIT |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48235-4116 |
Practice Address - Country: | US |
Practice Address - Phone: | 313-673-1338 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-05-25 |
Last Update Date: | 2010-05-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174H00000X | Other Service Providers | Health Educator | Group - Multi-Specialty | |
No | 172V00000X | Other Service Providers | Community Health Worker | Group - Multi-Specialty |