Provider Demographics
NPI:1780898064
Name:MARY'S CHILDREN FAMILY CENTER
Entity type:Organization
Organization Name:MARY'S CHILDREN FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WICHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-307-0242
Mailing Address - Street 1:495 E 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-2111
Mailing Address - Country:US
Mailing Address - Phone:248-307-0242
Mailing Address - Fax:
Practice Address - Street 1:495 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-2111
Practice Address - Country:US
Practice Address - Phone:248-307-0242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251C00000X
373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services