Provider Demographics
NPI: | 1033488879 |
---|---|
Name: | LOGICAL CHOICE LLC |
Entity Type: | Organization |
Organization Name: | LOGICAL CHOICE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PROGRAM DIRECTOR |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | KIETRIC |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | JENKINS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 313-643-5542 |
Mailing Address - Street 1: | 5575 CONNER ST. |
Mailing Address - Street 2: | SUITE 210 |
Mailing Address - City: | DETROIT |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48213-6400 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 313-643-5542 |
Mailing Address - Fax: | 248-522-7045 |
Practice Address - Street 1: | 5575 CONNER ST. |
Practice Address - Street 2: | SUITE 210 |
Practice Address - City: | DETROIT |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48213-6400 |
Practice Address - Country: | US |
Practice Address - Phone: | 313-643-5542 |
Practice Address - Fax: | 248-522-7045 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-12-23 |
Last Update Date: | 2011-12-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health | |
No | 251B00000X | Agencies | Case Management | |
No | 252Y00000X | Agencies | Early Intervention Provider Agency |