Provider Demographics
NPI:1689238818
Name:SEAN GILES REDEMPTION THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:SEAN GILES REDEMPTION THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GENEVA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:313-978-8073
Mailing Address - Street 1:PO BOX 19398
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-0398
Mailing Address - Country:US
Mailing Address - Phone:313-978-8073
Mailing Address - Fax:
Practice Address - Street 1:13160 W OUTER DR APT 123
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-3187
Practice Address - Country:US
Practice Address - Phone:313-978-8073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty