Provider Demographics
NPI:1265705578
Name:BEYOND BOUNDARIES
Entity type:Organization
Organization Name:BEYOND BOUNDARIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-355-2624
Mailing Address - Street 1:11274 MOORE ST.
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174
Mailing Address - Country:US
Mailing Address - Phone:734-355-2624
Mailing Address - Fax:313-331-1912
Practice Address - Street 1:5706 S WAYNE RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2913
Practice Address - Country:US
Practice Address - Phone:734-355-2624
Practice Address - Fax:313-331-1912
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOODS CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820313478171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty