Provider Demographics
NPI:1710342233
Name:DUETEL BABIES
Entity Type:Organization
Organization Name:DUETEL BABIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRICILLA
Authorized Official - Middle Name:BLANCHE
Authorized Official - Last Name:PICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-796-2599
Mailing Address - Street 1:25225 GREENFIELD RD
Mailing Address - Street 2:APT 1203
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2150
Mailing Address - Country:US
Mailing Address - Phone:248-796-2599
Mailing Address - Fax:
Practice Address - Street 1:25225 GREENFIELD RD
Practice Address - Street 2:APT 1203
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2150
Practice Address - Country:US
Practice Address - Phone:248-796-2599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency