Provider Demographics
NPI:1659428167
Name:METHODIST CHILDREN'S HOME SOCIETY
Entity Type:Organization
Organization Name:METHODIST CHILDREN'S HOME SOCIETY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. EXEC. DIRECTOR - FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-531-9970
Mailing Address - Street 1:26645 W 6 MILE RD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-2319
Mailing Address - Country:US
Mailing Address - Phone:313-153-1406
Mailing Address - Fax:313-531-1040
Practice Address - Street 1:26645 W 6 MILE RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-2319
Practice Address - Country:US
Practice Address - Phone:313-531-4060
Practice Address - Fax:313-531-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC1820201294322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children