Provider Demographics
NPI:1922454537
Name:MAAT MIHP
Entity Type:Organization
Organization Name:MAAT MIHP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:ADJWOA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:810-986-2873
Mailing Address - Street 1:13560 E MCNICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-3426
Mailing Address - Country:US
Mailing Address - Phone:248-977-9948
Mailing Address - Fax:
Practice Address - Street 1:13560 E MCNICHOLS
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-3651
Practice Address - Country:US
Practice Address - Phone:248-977-9948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1922454537Medicaid