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Organization
TUCKERVILLE.LLC
Active
Organization
TUCKERVILLE.LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FARTIMA TUCKER LMSW, IMH-E(II) (CEO/OWNER)
(313) 303-7423
Entity
Organization
Contact information
Practice address
35230 E MICHIGAN AVE, WAYNE, MI 48184-3698
(313) 312-5706
Mailing address
PO BOX 125, BELLEVILLE, MI 48112-0125
(313) 303-7423
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
251E00000X
Home Health Agency
Primary
E79564
MI
251K00000X
Public Health or Welfare Agency
E79564
MI
253Z00000X
In Home Supportive Care Agency
E79564
MI
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
302R00000X
Health Maintenance Organization
E79564
MI
Other
Enumeration date
02/02/2016
Last updated
03/24/2023
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