Provider Demographics
NPI:1053663633
Name:HANDS ACROSS THE WATER, INC
Entity Type:Organization
Organization Name:HANDS ACROSS THE WATER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-477-0135
Mailing Address - Street 1:781 AVIS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-8959
Mailing Address - Country:US
Mailing Address - Phone:734-477-0135
Mailing Address - Fax:734-477-0213
Practice Address - Street 1:781 AVIS DR STE 200
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-8959
Practice Address - Country:US
Practice Address - Phone:734-477-0135
Practice Address - Fax:734-477-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 104100000X, 106H00000X
MICB810201161251B00000X, 251S00000X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No253J00000XAgenciesFoster Care Agency