Provider Demographics
NPI:1518226323
Name:FAMILY SUPPORT SERVICES FOR MENTAL RECOVERY
Entity Type:Organization
Organization Name:FAMILY SUPPORT SERVICES FOR MENTAL RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:810-732-9160
Mailing Address - Street 1:G3445 MACKIN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-3280
Mailing Address - Country:US
Mailing Address - Phone:810-732-9160
Mailing Address - Fax:
Practice Address - Street 1:G3445 MACKIN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-3280
Practice Address - Country:US
Practice Address - Phone:810-732-9160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS250010767320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness