Provider Demographics
NPI:1083997019
Name:ENNIS CENTER FOR CHILDREN
Entity Type:Organization
Organization Name:ENNIS CENTER FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE/HR
Authorized Official - Prefix:MS
Authorized Official - First Name:GALE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-233-4031
Mailing Address - Street 1:129 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1728
Mailing Address - Country:US
Mailing Address - Phone:810-233-4031
Mailing Address - Fax:810-234-0817
Practice Address - Street 1:129 E 3RD ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1728
Practice Address - Country:US
Practice Address - Phone:810-233-4031
Practice Address - Fax:810-234-0817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801079960251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health