Provider Demographics
NPI:1528572393
Name:ABRAMS, SANDRA LENITA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LENITA
Last Name:ABRAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:
Other - Last Name:ABRAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:225 ELOISE DR
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-6513
Mailing Address - Country:US
Mailing Address - Phone:269-221-0250
Mailing Address - Fax:269-252-5066
Practice Address - Street 1:225 ELOISE DR
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-6513
Practice Address - Country:US
Practice Address - Phone:269-221-0250
Practice Address - Fax:269-252-5066
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF110380112253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency