Provider Demographics
NPI:1275882623
Name:MCH PROGRAM
Entity Type:Organization
Organization Name:MCH PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TENETIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-338-6226
Mailing Address - Street 1:2567 ASHLAND ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2501
Mailing Address - Country:US
Mailing Address - Phone:313-338-6226
Mailing Address - Fax:
Practice Address - Street 1:2567 ASHLAND ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2501
Practice Address - Country:US
Practice Address - Phone:313-338-6226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIVE HOPE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable