Provider Demographics
NPI:1407079882
Name:POSITIVE IMAGES
Entity Type:Organization
Organization Name:POSITIVE IMAGES
Other - Org Name:POSITIVE IMAGES 3
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENYATTA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-822-6940
Mailing Address - Street 1:13340 E WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2112
Mailing Address - Country:US
Mailing Address - Phone:313-822-6940
Mailing Address - Fax:313-822-6946
Practice Address - Street 1:694 E GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-2526
Practice Address - Country:US
Practice Address - Phone:313-822-6940
Practice Address - Fax:313-822-6946
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POSITIVE IMAGES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-11
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI821843324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility