Provider Demographics
NPI:1811429798
Name:MIZPAH GROUP HOME INC
Entity type:Organization
Organization Name:MIZPAH GROUP HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALONZO
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MS
Authorized Official - Phone:248-796-2639
Mailing Address - Street 1:24375 LAFAYETTE CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2560
Mailing Address - Country:US
Mailing Address - Phone:248-796-2639
Mailing Address - Fax:248-796-2639
Practice Address - Street 1:24375 LAFAYETTE CIR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2560
Practice Address - Country:US
Practice Address - Phone:248-796-2639
Practice Address - Fax:248-796-2639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable