Provider Demographics
NPI:1467958231
Name:SHAUNIAS GIFT OF LOVE ADULT DAY
Entity Type:Organization
Organization Name:SHAUNIAS GIFT OF LOVE ADULT DAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:WORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-502-1138
Mailing Address - Street 1:28032 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2654
Mailing Address - Country:US
Mailing Address - Phone:734-742-5150
Mailing Address - Fax:734-742-5149
Practice Address - Street 1:28032 WARREN RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2654
Practice Address - Country:US
Practice Address - Phone:734-742-5150
Practice Address - Fax:734-742-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty