Provider Demographics
NPI:1265675896
Name:CARING MATERNAL/INFANT HEALTH PROGRAM, INC.
Entity Type:Organization
Organization Name:CARING MATERNAL/INFANT HEALTH PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIHP COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ETTA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:BAGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:248-227-0167
Mailing Address - Street 1:22664 W 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-4711
Mailing Address - Country:US
Mailing Address - Phone:248-227-0167
Mailing Address - Fax:248-996-9750
Practice Address - Street 1:22664 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-4711
Practice Address - Country:US
Practice Address - Phone:248-227-0167
Practice Address - Fax:248-996-9750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health