Provider Demographics
NPI:1295844454
Name:SERVICES TO ENHANCE POTENTIAL
Entity Type:Organization
Organization Name:SERVICES TO ENHANCE POTENTIAL
Other - Org Name:WAYNE COUNTY ASSOCIATION FOR THE RETARDED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEHIF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:VALASCO
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:313-278-3040
Mailing Address - Street 1:2941 S GULLEY RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3160
Mailing Address - Country:US
Mailing Address - Phone:313-278-3040
Mailing Address - Fax:
Practice Address - Street 1:2941 S GULLEY RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3160
Practice Address - Country:US
Practice Address - Phone:313-278-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2616746Medicaid