Provider Demographics
NPI:1710335955
Name:MOMS DADS &BABES
Entity Type:Organization
Organization Name:MOMS DADS &BABES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALTHEA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:KYLES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLPC,LBSW,QMHP
Authorized Official - Phone:248-727-8327
Mailing Address - Street 1:9254 TRINITY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1633
Mailing Address - Country:US
Mailing Address - Phone:248-727-8327
Mailing Address - Fax:
Practice Address - Street 1:9254 TRINITY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1633
Practice Address - Country:US
Practice Address - Phone:248-727-8327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care