Provider Demographics
NPI:1144582149
Name:THE LIVING ROOM DROP IN CENTER
Entity Type:Organization
Organization Name:THE LIVING ROOM DROP IN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:BA, CPSS, MH ED,
Authorized Official - Phone:313-623-1712
Mailing Address - Street 1:2780 E GRAND BLVD STREET
Mailing Address - Street 2:200
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2427
Mailing Address - Country:US
Mailing Address - Phone:313-638-1712
Mailing Address - Fax:
Practice Address - Street 1:700 SEWARD ST
Practice Address - Street 2:512
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2427
Practice Address - Country:US
Practice Address - Phone:313-638-1712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI302R00000X302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization