Provider Demographics
NPI:1881871895
Name:KIMBERLY ANN ALABI-ISAMA
Entity type:Organization
Organization Name:KIMBERLY ANN ALABI-ISAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ALABI-ISAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-446-9658
Mailing Address - Street 1:2921 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4267
Mailing Address - Country:US
Mailing Address - Phone:313-446-9658
Mailing Address - Fax:313-446-1493
Practice Address - Street 1:1620 N FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-3751
Practice Address - Country:US
Practice Address - Phone:313-446-9658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness