Provider Demographics
NPI:1518749613
Name:PALLIATIVE COACH MICHIGAN
Entity Type:Organization
Organization Name:PALLIATIVE COACH MICHIGAN
Other - Org Name:PALLIATIVE COACH MICHIGAN
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKLYN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-420-1117
Mailing Address - Street 1:24889 BEACH DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-4558
Mailing Address - Country:US
Mailing Address - Phone:586-420-1117
Mailing Address - Fax:
Practice Address - Street 1:24889 BEACH DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-4558
Practice Address - Country:US
Practice Address - Phone:586-420-1117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty