Provider Demographics
NPI:1700564903
Name:INNERMAN COMMUNITY OUTREACH SERVICES
Entity Type:Organization
Organization Name:INNERMAN COMMUNITY OUTREACH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLISON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:313-656-7972
Mailing Address - Street 1:239 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2725
Mailing Address - Country:US
Mailing Address - Phone:313-656-7972
Mailing Address - Fax:
Practice Address - Street 1:239 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2725
Practice Address - Country:US
Practice Address - Phone:313-656-7972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care