Provider Demographics
NPI:1891825808
Name:NEIGHBORHOOD SERVICE ORGANIZATION
Entity Type:Organization
Organization Name:NEIGHBORHOOD SERVICE ORGANIZATION
Other - Org Name:NSO
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-961-4890
Mailing Address - Street 1:882 OAKMAN BLVD
Mailing Address - Street 2:STE. C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-3710
Mailing Address - Country:US
Mailing Address - Phone:313-961-4890
Mailing Address - Fax:313-867-3675
Practice Address - Street 1:882 OAKMAN BLVD
Practice Address - Street 2:STE. C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-3710
Practice Address - Country:US
Practice Address - Phone:313-961-4890
Practice Address - Fax:313-867-3675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3273262Medicaid
MI3273370Medicaid
MI4161019Medicaid
MI4373960Medicaid
MI4512769Medicaid
MI4678149Medicaid
MI0P03970OtherMEDICARE PIN NUMBER
MI3273271Medicaid
MI600501OtherCONSUMERLINK PROVIDER NUM
MI3273280Medicaid
MI4465471Medicaid
MI4675817Medicaid
MI4652438Medicaid
MI053720OtherCARELINK PROVIDER NUMBER
MI13493OtherDETROIT WAYNE ID NUMBER
MI669973OtherCONSUMERLINK PROVIDER NUM
MI3273315Medicaid
MI4354472Medicaid
MI4373960Medicaid
MI4465471Medicaid