Provider Demographics
NPI:1447530175
Name:REALITY CHECK DETROIT
Entity type:Organization
Organization Name:REALITY CHECK DETROIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF BUSINESS DEVELOPER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-585-9733
Mailing Address - Street 1:PO BOX 23442
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-0442
Mailing Address - Country:US
Mailing Address - Phone:313-585-9733
Mailing Address - Fax:
Practice Address - Street 1:18845 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-4132
Practice Address - Country:US
Practice Address - Phone:313-585-9733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health