Provider Demographics
NPI:1689240921
Name:JUSTIN CHARGE ENTERPRISES INC
Entity Type:Organization
Organization Name:JUSTIN CHARGE ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SUPPORTS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:BA QIDP QMHP
Authorized Official - Phone:586-610-3656
Mailing Address - Street 1:37156 ROBINHOOD DR APT 111
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2382
Mailing Address - Country:US
Mailing Address - Phone:586-610-3656
Mailing Address - Fax:586-250-0425
Practice Address - Street 1:37156 ROBINHOOD DR APT 111
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-2382
Practice Address - Country:US
Practice Address - Phone:586-610-3656
Practice Address - Fax:586-250-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management