Provider Demographics
NPI:1124196415
Name:MULTIDIMENSIONS CARE MANAGEMENT
Entity Type:Organization
Organization Name:MULTIDIMENSIONS CARE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:WILLIS
Authorized Official - Last Name:COLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-864-2987
Mailing Address - Street 1:17555 JAMES COUZENS FWY
Mailing Address - Street 2:2-WEST
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2657
Mailing Address - Country:US
Mailing Address - Phone:313-864-2987
Mailing Address - Fax:313-864-2142
Practice Address - Street 1:17555 JAMES COUZENS FWY
Practice Address - Street 2:2 WEST
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2657
Practice Address - Country:US
Practice Address - Phone:313-864-2987
Practice Address - Fax:313-864-2142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010340961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI096642OtherVALUE OPTIONS PROVIDER #
MION28480Medicare ID - Type UnspecifiedPROVIDER NUMBER