Provider Demographics
NPI:1679050504
Name:TURNER SEGUE HOME
Entity Type:Organization
Organization Name:TURNER SEGUE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CACIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-818-0300
Mailing Address - Street 1:18701 GRAND RIVER AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-2214
Mailing Address - Country:US
Mailing Address - Phone:313-574-0795
Mailing Address - Fax:
Practice Address - Street 1:2222 LOTHROP ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2672
Practice Address - Country:US
Practice Address - Phone:313-818-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820317905253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency