Provider Demographics
NPI:1669552931
Name:P.A.L.S., INC
Entity type:Organization
Organization Name:P.A.L.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:BSW, CSW
Authorized Official - Phone:313-561-3360
Mailing Address - Street 1:6500 N INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1807
Mailing Address - Country:US
Mailing Address - Phone:313-561-3360
Mailing Address - Fax:313-561-3347
Practice Address - Street 1:6500 N INKSTER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1807
Practice Address - Country:US
Practice Address - Phone:313-561-3360
Practice Address - Fax:313-561-3347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS20014119302F00000X
MI302F00000X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization