Provider Demographics
NPI:1144424680
Name:METROPOLITAN AGENCY FOR RETARDED
Entity Type:Organization
Organization Name:METROPOLITAN AGENCY FOR RETARDED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINCIAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-965-6655
Mailing Address - Street 1:65 CADILLAC SQ
Mailing Address - Street 2:SUITE 2933
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-2844
Mailing Address - Country:US
Mailing Address - Phone:313-965-6655
Mailing Address - Fax:313-965-3976
Practice Address - Street 1:65 CADILLAC SQ
Practice Address - Street 2:SUITE 2933
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-2844
Practice Address - Country:US
Practice Address - Phone:313-965-6655
Practice Address - Fax:313-965-3976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare