| Ennis Center For Children, Inc. | |
|
129 E 3rd St Flint MI 48502 | |
| (810) 233-4031 | |
| (810) 237-4141 |
| Full Name | Ennis Center For Children, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 129 E 3rd St, Flint, Michigan |
| Authorized Official Name and Position | Robert E. Ennis (PRESIDENT) |
| Authorized Official Contact | 8102334031 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ennis Center For Children, Inc. 129 E 3rd St Flint MI 48502-1728 Ph: (810) 233-4031 | Ennis Center For Children, Inc. 129 E 3rd St Flint MI 48502 Ph: (810) 233-4031 |
| NPI Number | 1851520589 |
|---|---|
| Provider Enumeration Date | 07/02/2009 |
| Last Update Date | 08/16/2018 |
| Medicare PECOS PAC ID | 1052558194 |
|---|---|
| Medicare Enrollment ID | O20130509000567 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851520589 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 253J00000X | Foster Care Agency | (* (Not Available)) | Secondary |
| Provider Name | Gail L Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902044308 PECOS PAC ID: 6608927082 Enrollment ID: I20090624000581 |
| Provider Name | Danielle Giles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013420645 PECOS PAC ID: 2668709296 Enrollment ID: I20190806000315 |
| Provider Name | Tracy Hillary Bishop |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427176114 PECOS PAC ID: 2567882079 Enrollment ID: I20201022002618 |
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