Provider Demographics
NPI:1073239638
Name:CHILDS, STEPHANIE C
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:C
Last Name:CHILDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18640 MACK AVE UNIT 36574
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-7725
Mailing Address - Country:US
Mailing Address - Phone:470-422-0344
Mailing Address - Fax:
Practice Address - Street 1:5261 DEVONSHIRE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-3232
Practice Address - Country:US
Practice Address - Phone:678-638-9517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health