Provider Demographics
NPI:1467758789
Name:MIZPAH GROUP HOME INC
Entity Type:Organization
Organization Name:MIZPAH GROUP HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALONZO
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MA
Authorized Official - Phone:248-796-2639
Mailing Address - Street 1:31058 WHEATON
Mailing Address - Street 2:201
Mailing Address - City:NEW HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:48165-9469
Mailing Address - Country:US
Mailing Address - Phone:248-796-2639
Mailing Address - Fax:
Practice Address - Street 1:31058 WHEATON
Practice Address - Street 2:201
Practice Address - City:NEW HUDSON
Practice Address - State:MI
Practice Address - Zip Code:48165-9469
Practice Address - Country:US
Practice Address - Phone:248-796-2639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child