Provider Demographics
NPI:1043520620
Name:A MOTHER'S PROMISE
Entity Type:Organization
Organization Name:A MOTHER'S PROMISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:REID-WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-768-8613
Mailing Address - Street 1:1033 MARYLAND ST
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1365
Mailing Address - Country:US
Mailing Address - Phone:313-768-8613
Mailing Address - Fax:313-469-7313
Practice Address - Street 1:13123 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2016
Practice Address - Country:US
Practice Address - Phone:313-768-8613
Practice Address - Fax:313-469-7313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0015828OtherHOME HELPER PROVIDER