Organization
REBIRTH COMMUNITY INCLUSION PROGRAM
Active
Other names
aroma coffeehouse
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA TERESA JEFFERSON MA,LLPC,CCS,CAADC (CHIELF EXECUTIVE OFFICER)
(313) 418-5667
Entity
Organization
Contact information
Practice address
16951 MARYLAND ST, SOUTHFIELD, MI 48075-2903
(313) 418-5667
Mailing address
16951 MARYLAND, DETROIT, MI 48228
(313) 418-5667
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902926207
—
MI
Enumeration date
04/21/2017
Last updated
07/21/2022
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