Provider Demographics
NPI:1629318126
Name:HADASSAH & COMPANY PLLC
Entity Type:Organization
Organization Name:HADASSAH & COMPANY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:313-404-5004
Mailing Address - Street 1:19855 OUTER DR
Mailing Address - Street 2:SUITE 504E
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2022
Mailing Address - Country:US
Mailing Address - Phone:313-404-5004
Mailing Address - Fax:734-451-0603
Practice Address - Street 1:19855 OUTER DR
Practice Address - Street 2:SUITE 504E
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2022
Practice Address - Country:US
Practice Address - Phone:313-404-5004
Practice Address - Fax:734-451-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801070324251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicare PIN