Organization
CALDWELL THOMPSON MANOR INTERNATIONAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PATRICIA GIBBS LMSW, ACSW (MANAGER)
(313) 924-9478
Entity
Organization
Contact information
Practice address
8537 VAN DYKE ST, DETROIT, MI 48213-2374
(313) 924-9478
(313) 924-9494
Mailing address
23636 CUNNINGHAM AVE, WARREN, MI 48091-3181
(313) 924-9478
(313) 924-9494
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801061937
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225253461
NPI
MI
01
—
8008950700
BLUE CROSS BLUE SHIELD
—
Enumeration date
05/13/2009
Last updated
05/13/2009
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