Provider Demographics
NPI:1255665436
Name:MAKA SIL & GROUP HOME, INC
Entity Type:Organization
Organization Name:MAKA SIL & GROUP HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:313-347-6334
Mailing Address - Street 1:24123 GREENFIELD RD
Mailing Address - Street 2:STE 307
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3125
Mailing Address - Country:US
Mailing Address - Phone:248-595-8108
Mailing Address - Fax:248-595-8237
Practice Address - Street 1:24123 GREENFIELD RD
Practice Address - Street 2:STE 307
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3125
Practice Address - Country:US
Practice Address - Phone:248-595-8108
Practice Address - Fax:248-595-8237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty