Provider Demographics
NPI:1558758862
Name:OUR SPECIAL GEMS
Entity Type:Organization
Organization Name:OUR SPECIAL GEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LENDEN
Authorized Official - Middle Name:SAVANAH
Authorized Official - Last Name:FAVORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-207-6571
Mailing Address - Street 1:9116 GRAYFIELD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1132
Mailing Address - Country:US
Mailing Address - Phone:313-207-6571
Mailing Address - Fax:
Practice Address - Street 1:9116 GRAYFIELD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1132
Practice Address - Country:US
Practice Address - Phone:313-207-6571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171M00000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty