Provider Demographics
NPI:1558544429
Name:POEM HUMANSERVICE DEVELOPMENT CORP.
Entity Type:Organization
Organization Name:POEM HUMANSERVICE DEVELOPMENT CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:MORRIS
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:CACM
Authorized Official - Phone:313-896-7238
Mailing Address - Street 1:3372 18TH ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2550
Mailing Address - Country:US
Mailing Address - Phone:313-896-7238
Mailing Address - Fax:
Practice Address - Street 1:4720 JUNCTION ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-2518
Practice Address - Country:US
Practice Address - Phone:313-410-1829
Practice Address - Fax:313-896-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-00079251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health