Provider Demographics
NPI:1720355613
Name:WAYNE COUNTY JAIL
Entity Type:Organization
Organization Name:WAYNE COUNTY JAIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:AGRON
Authorized Official - Middle Name:
Authorized Official - Last Name:MYFTARI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:3133-824-9377
Mailing Address - Street 1:570 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-2334
Mailing Address - Country:US
Mailing Address - Phone:313-224-0715
Mailing Address - Fax:
Practice Address - Street 1:570 CLINTON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-2334
Practice Address - Country:US
Practice Address - Phone:313-224-0715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801071336283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital