Provider Demographics
NPI:1255877668
Name:CHURCH OF GOD IN CHRIST SOCIAL SERVICES OF MICHIGAN
Entity type:Organization
Organization Name:CHURCH OF GOD IN CHRIST SOCIAL SERVICES OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:313-320-6489
Mailing Address - Street 1:15350 SOUTHFIELD FWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-1359
Mailing Address - Country:US
Mailing Address - Phone:313-398-2238
Mailing Address - Fax:313-398-2152
Practice Address - Street 1:15350 SOUTHFIELD FWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-1359
Practice Address - Country:US
Practice Address - Phone:313-398-2238
Practice Address - Fax:313-398-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health