Provider Demographics
NPI:1881461481
Name:IN HONOR OF BRENDA DENISE PARKS THE HUG FOUNDATION
Entity type:Organization
Organization Name:IN HONOR OF BRENDA DENISE PARKS THE HUG FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEONDRA
Authorized Official - Middle Name:SHALAN
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-845-0276
Mailing Address - Street 1:PO BOX 48396
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-5996
Mailing Address - Country:US
Mailing Address - Phone:248-845-0276
Mailing Address - Fax:
Practice Address - Street 1:17376 W 12 MILE RD STE 202
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-6303
Practice Address - Country:US
Practice Address - Phone:248-845-0276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty