Provider Demographics
NPI:1609825124
Name:SYNOD RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:SYNOD RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KETA
Authorized Official - Middle Name:J
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:734-483-9363
Mailing Address - Street 1:PO BOX 980465
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-0465
Mailing Address - Country:US
Mailing Address - Phone:734-483-9363
Mailing Address - Fax:734-483-9557
Practice Address - Street 1:615 S MANSFIELD ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5156
Practice Address - Country:US
Practice Address - Phone:734-483-9363
Practice Address - Fax:734-483-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness