Provider Demographics
NPI:1164842829
Name:BABY STEPS MATERNAL AND INFANT HEALTH PROGRAM LLC
Entity Type:Organization
Organization Name:BABY STEPS MATERNAL AND INFANT HEALTH PROGRAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,CRC,LBSW
Authorized Official - Phone:248-403-4435
Mailing Address - Street 1:PO BOX 3725
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-3725
Mailing Address - Country:US
Mailing Address - Phone:248-403-4435
Mailing Address - Fax:248-352-3907
Practice Address - Street 1:6318 DEXTER ST
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-1832
Practice Address - Country:US
Practice Address - Phone:248-403-4435
Practice Address - Fax:248-352-3907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty