Provider Demographics
NPI:1124211701
Name:MICHIGAN HABILITATION AND LEARNING CENTER, INC
Entity Type:Organization
Organization Name:MICHIGAN HABILITATION AND LEARNING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MEDHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:EGZIABHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-539-3209
Mailing Address - Street 1:6784 W KNOLLWOOD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3959
Mailing Address - Country:US
Mailing Address - Phone:248-539-3209
Mailing Address - Fax:248-424-9957
Practice Address - Street 1:6784 W KNOLLWOOD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3959
Practice Address - Country:US
Practice Address - Phone:248-539-3209
Practice Address - Fax:248-424-9957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities