Provider Demographics
NPI:1164878294
Name:BORN FOR ME LLC
Entity Type:Organization
Organization Name:BORN FOR ME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-215-6395
Mailing Address - Street 1:PO BOX 14513
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-0513
Mailing Address - Country:US
Mailing Address - Phone:313-215-6395
Mailing Address - Fax:
Practice Address - Street 1:19323 STANSBURY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1733
Practice Address - Country:US
Practice Address - Phone:313-215-6395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-07
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085319251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management