Organization
PR KIDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH SHANNON PIERSON (EXECUTIVE DIRECTOR)
(586) 855-9676
Entity
Organization
Contact information
Practice address
18223 MCINTYRE ST, DETROIT, MI 48219-2366
(586) 855-9676
Mailing address
12679 LONGTIN ST, SOUTHGATE, MI 48195-1770
(586) 855-9676
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
11/01/2016
Last updated
11/01/2016
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