Provider Demographics
NPI:1134848542
Name:MARY S YOUNG ADULTS DAY CARE, INC
Entity type:Organization
Organization Name:MARY S YOUNG ADULTS DAY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IMMACULATA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSUEKE
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:248-250-4183
Mailing Address - Street 1:21860 STRATFORD ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2534
Mailing Address - Country:US
Mailing Address - Phone:248-250-4183
Mailing Address - Fax:
Practice Address - Street 1:9728 BROADSTREET AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-1642
Practice Address - Country:US
Practice Address - Phone:248-250-4183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty