Provider Demographics
NPI:1982859849
Name:TODD-PHILLIPS CHILDREN'S HOME
Entity Type:Organization
Organization Name:TODD-PHILLIPS CHILDREN'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ZELDA
Authorized Official - Middle Name:REE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-556-8030
Mailing Address - Street 1:1151 TAYLOR ST UNIT 3A4A
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1732
Mailing Address - Country:US
Mailing Address - Phone:313-556-8030
Mailing Address - Fax:313-556-8036
Practice Address - Street 1:1151 TAYLOR ST UNIT 3A4A
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1732
Practice Address - Country:US
Practice Address - Phone:313-556-8030
Practice Address - Fax:313-556-8036
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TODD-PHILLIPS CHILDREN'S HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI823045324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI801-098 (CID)Medicaid