Provider Demographics
NPI:1881921401
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:MSW, LMSW
Authorized Official - Phone:313-372-4350
Mailing Address - Street 1:8141 E OUTER DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-1323
Mailing Address - Country:US
Mailing Address - Phone:313-372-4350
Mailing Address - Fax:313-372-4360
Practice Address - Street 1:8141 E OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-1323
Practice Address - Country:US
Practice Address - Phone:313-372-4350
Practice Address - Fax:313-372-4360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8230453245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children