Provider Demographics
NPI:1386824274
Name:MICHIGAN INSTITUTE FOR HEALTH ENHANCEMENT, LLC
Entity Type:Organization
Organization Name:MICHIGAN INSTITUTE FOR HEALTH ENHANCEMENT, LLC
Other - Org Name:MIHE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:EWA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATUSZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-909-9930
Mailing Address - Street 1:4986 N ADAMS RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-5017
Mailing Address - Country:US
Mailing Address - Phone:248-475-4840
Mailing Address - Fax:248-475-4881
Practice Address - Street 1:4986 N ADAMS RD
Practice Address - Street 2:SUITE E
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306-5017
Practice Address - Country:US
Practice Address - Phone:248-475-4840
Practice Address - Fax:248-475-4881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL NETWORK ONE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty