Provider Demographics
NPI:1639386907
Name:CALDWELL-THOMPSON MANOR
Entity Type:Organization
Organization Name:CALDWELL-THOMPSON MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LOUISA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-757-2357
Mailing Address - Street 1:618 HARMON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1332
Mailing Address - Country:US
Mailing Address - Phone:313-924-9485
Mailing Address - Fax:313-924-9494
Practice Address - Street 1:618 HARMON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1332
Practice Address - Country:US
Practice Address - Phone:313-924-9485
Practice Address - Fax:313-924-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010584501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N90540Medicare PIN