Provider Demographics
NPI:1174028823
Name:OUT OF ASHES LLC
Entity Type:Organization
Organization Name:OUT OF ASHES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELF
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KALBFLEISCH
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-394-1598
Mailing Address - Street 1:2118 VAN ANTWERP ST
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1625
Mailing Address - Country:US
Mailing Address - Phone:810-394-1598
Mailing Address - Fax:
Practice Address - Street 1:135 N RIVERBANK ST
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-2707
Practice Address - Country:US
Practice Address - Phone:810-394-1598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty