Provider Demographics
NPI:1689098121
Name:ENNIS CENTER FOR CHILDREN, INC
Entity Type:Organization
Organization Name:ENNIS CENTER FOR CHILDREN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-233-4031
Mailing Address - Street 1:129 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1728
Mailing Address - Country:US
Mailing Address - Phone:810-233-4031
Mailing Address - Fax:810-237-4141
Practice Address - Street 1:20100 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-342-2699
Practice Address - Fax:313-342-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty