Organization
EDUCATING U4 LIFE CDC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALBERT EUGENE MACK (EXECUTIVE DIRECTOR)
(877) 267-3491
Entity
Organization
Contact information
Practice address
19321 W CHICAGO ST, DETROIT, MI 48228-1739
(877) 267-3491
Mailing address
22503 GRAND RIVER AVE, SUITE 19653, DETROIT, MI 48219-5034
(877) 267-3491
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
6801011686
MI
252Y00000X
Early Intervention Provider Agency
6801046708
MI
Other
Enumeration date
04/26/2017
Last updated
07/25/2019
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