Provider Demographics
NPI:1033253794
Name:CHILDREN'S AMBULATORY SERVICES, LLC
Entity Type:Organization
Organization Name:CHILDREN'S AMBULATORY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:VP
Authorized Official - Phone:313-745-0633
Mailing Address - Street 1:3901 BEAUBIEN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2119
Mailing Address - Country:US
Mailing Address - Phone:313-745-0633
Mailing Address - Fax:313-745-5395
Practice Address - Street 1:21431 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3801
Practice Address - Country:US
Practice Address - Phone:313-745-0633
Practice Address - Fax:313-745-0633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health