Provider Demographics
NPI:1982085015
Name:PENNIE OHIA
Entity Type:Organization
Organization Name:PENNIE OHIA
Other - Org Name:MICHIGAN AUTISM ACADEMY FOR STAFF AND OC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:PENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OHIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-915-2236
Mailing Address - Street 1:17500 NORTHLAND PARK CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4324
Mailing Address - Country:US
Mailing Address - Phone:313-915-2236
Mailing Address - Fax:
Practice Address - Street 1:17500 NORTHLAND PARK CT
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4324
Practice Address - Country:US
Practice Address - Phone:313-915-2236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7831918Medicaid