Provider Demographics
NPI:1184836082
Name:KADIMA JEWISH SUPPORT SERVICES FOR ADULTS WITH MENTAL ILLNESS
Entity Type:Organization
Organization Name:KADIMA JEWISH SUPPORT SERVICES FOR ADULTS WITH MENTAL ILLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALLAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-559-8235
Mailing Address - Street 1:15999 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-7159
Mailing Address - Country:US
Mailing Address - Phone:248-559-8235
Mailing Address - Fax:248-423-9318
Practice Address - Street 1:15999 WEST 12 MILE ROAD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48382
Practice Address - Country:US
Practice Address - Phone:248-559-8235
Practice Address - Fax:248-423-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M09230Medicare ID - Type UnspecifiedPROVIDER NUMBER