Provider Demographics
NPI:1619262631
Name:ALLEN FOSTER REDEEMER OUTREACH
Entity Type:Organization
Organization Name:ALLEN FOSTER REDEEMER OUTREACH
Other - Org Name:FAITH & BLESSING'S MOM & BABY
Other - Org Type:Other Name
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVON
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:313-850-7818
Mailing Address - Street 1:18478 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2034
Mailing Address - Country:US
Mailing Address - Phone:313-850-7818
Mailing Address - Fax:313-255-4028
Practice Address - Street 1:18478 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221
Practice Address - Country:US
Practice Address - Phone:313-850-7818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801087359251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health