Provider Demographics
NPI:1891853479
Name:MOTHERS FRIEND MATERNAL INFANT SUPPORT SERVICES
Entity Type:Organization
Organization Name:MOTHERS FRIEND MATERNAL INFANT SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN COORDINATOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DASHUNA
Authorized Official - Middle Name:RELIEU
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-559-5722
Mailing Address - Street 1:16250 NORTHLAND DR
Mailing Address - Street 2:SUITE 239
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-559-5722
Mailing Address - Fax:248-559-5622
Practice Address - Street 1:16250 NORTHLAND DR
Practice Address - Street 2:SUITE 239
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-559-5722
Practice Address - Fax:248-559-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4556235Medicaid