Provider Demographics
NPI:1669096947
Name:GREAT START MIHP LLC
Entity type:Organization
Organization Name:GREAT START MIHP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-825-3029
Mailing Address - Street 1:36380 GARFIELD RD STE 4
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1162
Mailing Address - Country:US
Mailing Address - Phone:586-825-3029
Mailing Address - Fax:586-825-3028
Practice Address - Street 1:36380 GARFIELD RD STE 4
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-1162
Practice Address - Country:US
Practice Address - Phone:586-825-3029
Practice Address - Fax:586-825-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency