Provider Demographics
NPI:1881907053
Name:BAKERS COMMUNITY LLC
Entity type:Organization
Organization Name:BAKERS COMMUNITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:WILMA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-622-8201
Mailing Address - Street 1:8083 WARD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-2713
Mailing Address - Country:US
Mailing Address - Phone:313-622-8201
Mailing Address - Fax:
Practice Address - Street 1:1017 VINSETTA BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1020
Practice Address - Country:US
Practice Address - Phone:313-622-8201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS630302466320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness