Provider Demographics
NPI:1912227075
Name:JUDA TRANSITIONAL & RECOVERY HOUSE
Entity Type:Organization
Organization Name:JUDA TRANSITIONAL & RECOVERY HOUSE
Other - Org Name:RESTORATION NOW COMMUNITY DEVELOPMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALONZO
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MINISTER
Authorized Official - Phone:313-658-8925
Mailing Address - Street 1:5579 VANCOUVER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48204-3607
Mailing Address - Country:US
Mailing Address - Phone:313-556-5533
Mailing Address - Fax:313-556-5533
Practice Address - Street 1:5579 VANCOUVER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-3607
Practice Address - Country:US
Practice Address - Phone:313-556-5533
Practice Address - Fax:313-556-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI823123324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility