Provider Demographics
NPI:1497294805
Name:J&E PICKENS FAMILY,LLC
Entity Type:Organization
Organization Name:J&E PICKENS FAMILY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-992-7212
Mailing Address - Street 1:39245 NOTTINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-3729
Mailing Address - Country:US
Mailing Address - Phone:734-992-7212
Mailing Address - Fax:734-629-4773
Practice Address - Street 1:39245 NOTTINGHAM ST
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-3729
Practice Address - Country:US
Practice Address - Phone:734-992-7212
Practice Address - Fax:734-629-4773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1497294805.Medicaid