Provider Demographics
NPI:1356949390
Name:LIVONIA PUBLIC SCHOOLS SCHOOL DISTRICT
Entity type:Organization
Organization Name:LIVONIA PUBLIC SCHOOLS SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WAYNE HEALTH VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-448-9006
Mailing Address - Street 1:400 MACK AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2136
Mailing Address - Country:US
Mailing Address - Phone:313-448-9006
Mailing Address - Fax:
Practice Address - Street 1:8900 NEWBURGH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3425
Practice Address - Country:US
Practice Address - Phone:734-744-2650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY PHYSICIAN GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty