1891825808 NPI number — NEIGHBORHOOD SERVICE ORGANIZATION

Table of content: (NPI 1891825808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891825808 NPI number — NEIGHBORHOOD SERVICE ORGANIZATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIGHBORHOOD SERVICE ORGANIZATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NSO
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891825808
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
882 OAKMAN BLVD
Provider Second Line Business Mailing Address:
STE. C
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48238-3710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-961-4890
Provider Business Mailing Address Fax Number:
313-867-3675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
882 OAKMAN BLVD
Provider Second Line Business Practice Location Address:
STE. C
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48238-3710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-961-4890
Provider Business Practice Location Address Fax Number:
313-867-3675
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LITTLE
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
JOYCE
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
313-961-4890

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3273262 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3273370 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4161019 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4373960 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4512769 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4678149 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0P03970 . This is a "MEDICARE PIN NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3273271 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600501 . This is a "CONSUMERLINK PROVIDER NUM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3273280 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4465471 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4675817 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4652438 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 053720 . This is a "CARELINK PROVIDER NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 13493 . This is a "DETROIT WAYNE ID NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 669973 . This is a "CONSUMERLINK PROVIDER NUM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3273315 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4354472 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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