Provider Demographics
NPI:1639587199
Name:GREAT FUTURES MATERNAL INFANT HEALTH PROGRAM, LLC
Entity Type:Organization
Organization Name:GREAT FUTURES MATERNAL INFANT HEALTH PROGRAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:LASHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:313-737-0018
Mailing Address - Street 1:15892 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-5215
Mailing Address - Country:US
Mailing Address - Phone:313-737-0018
Mailing Address - Fax:
Practice Address - Street 1:15892 ORCHARD LN
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5215
Practice Address - Country:US
Practice Address - Phone:313-737-0018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802080544251B00000X, 251K00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health