Provider Demographics
NPI:1669614061
Name:STRONG YOUTH INITIATIVE MICHIGAN LLC
Entity type:Organization
Organization Name:STRONG YOUTH INITIATIVE MICHIGAN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-267-1899
Mailing Address - Street 1:2550 W GRAND BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-1239
Mailing Address - Country:US
Mailing Address - Phone:678-362-9955
Mailing Address - Fax:866-379-8708
Practice Address - Street 1:2550 W GRAND BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-1239
Practice Address - Country:US
Practice Address - Phone:678-362-9955
Practice Address - Fax:866-379-8708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care