Provider Demographics
NPI:1770032005
Name:THE COOKIE PROJECT
Entity Type:Organization
Organization Name:THE COOKIE PROJECT
Other - Org Name:MI COOKIE PROJECT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1734-626-3600
Mailing Address - Street 1:19621 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:MELVINDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48122-2201
Mailing Address - Country:US
Mailing Address - Phone:173-462-6360
Mailing Address - Fax:
Practice Address - Street 1:19621 WOOD ST
Practice Address - Street 2:
Practice Address - City:MELVINDALE
Practice Address - State:MI
Practice Address - Zip Code:48122-2201
Practice Address - Country:US
Practice Address - Phone:173-462-6360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services