Provider Demographics
NPI:1992182190
Name:NEIGHBORHOOD SERVICE ORGANIZATION
Entity Type:Organization
Organization Name:NEIGHBORHOOD SERVICE ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPORTS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KHADIJAH
Authorized Official - Middle Name:KARRIEM
Authorized Official - Last Name:CLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:LLBSW
Authorized Official - Phone:313-875-7601
Mailing Address - Street 1:8600 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2142
Mailing Address - Country:US
Mailing Address - Phone:313-875-7601
Mailing Address - Fax:313-875-7622
Practice Address - Street 1:8600 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2142
Practice Address - Country:US
Practice Address - Phone:313-875-7601
Practice Address - Fax:313-875-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802086947251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management