Provider Demographics
NPI:1174860134
Name:FIRST STEP TRANSITIONAL HOUSING
Entity Type:Organization
Organization Name:FIRST STEP TRANSITIONAL HOUSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-355-7345
Mailing Address - Street 1:79 RHODE ISLAND ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3356
Mailing Address - Country:US
Mailing Address - Phone:313-355-7345
Mailing Address - Fax:313-255-3947
Practice Address - Street 1:79 RHODE ISLAND ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3356
Practice Address - Country:US
Practice Address - Phone:313-355-7345
Practice Address - Fax:313-255-3947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801064874251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health