Organization
MISSIONARY SERVANTS OF DIVINE PROVIDENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTINA E UDEAGHA (ADMINISTRATOR/ DIRECTOR)
(734) 560-5014
Entity
Organization
Contact information
Practice address
26629 HOPKINS ST, INKSTER, MI 48141-3111
(734) 560-5014
(313) 633-9510
Mailing address
4101 MOORE ST, INKSTER, MI 48141-3017
(734) 560-5014
(313) 633-9510
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
6801084613
MI
251S00000X
Community/Behavioral Health Agency
Primary
6801084613
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578772240
—
MI
Enumeration date
09/22/2016
Last updated
03/08/2017
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