Provider Demographics
NPI:1336546597
Name:NIA-PURPOSE)
Entity Type:Organization
Organization Name:NIA-PURPOSE)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:RICHELLE
Authorized Official - Last Name:LUVENE
Authorized Official - Suffix:
Authorized Official - Credentials:LLBSW
Authorized Official - Phone:313-399-4825
Mailing Address - Street 1:8321 ESPER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48204-3121
Mailing Address - Country:US
Mailing Address - Phone:313-399-4825
Mailing Address - Fax:313-543-8469
Practice Address - Street 1:8321 ESPER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-3121
Practice Address - Country:US
Practice Address - Phone:313-399-4825
Practice Address - Fax:313-543-8469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIE4510M251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE4510MMedicaid