Provider Demographics
NPI:1548394331
Name:OPERATION GET DOWN
Entity Type:Organization
Organization Name:OPERATION GET DOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA,BA CAC CCJP
Authorized Official - Phone:313-921-9422
Mailing Address - Street 1:10100 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-3112
Mailing Address - Country:US
Mailing Address - Phone:313-921-9422
Mailing Address - Fax:313-571-9022
Practice Address - Street 1:10100 HARPER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3112
Practice Address - Country:US
Practice Address - Phone:313-921-9422
Practice Address - Fax:313-571-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI822054324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========Medicaid