Grateful Hearts Mihp | |
18444 W 10 Mile Rd Ste 200 Southfield MI 48075-2626 | |
(248) 702-4145 | |
Not Available |
Full Name | Grateful Hearts Mihp |
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Speciality | Social Worker |
Location | 18444 W 10 Mile Rd Ste 200, Southfield, Michigan |
Authorized Official Name and Position | Beth Lanette Baker Callen (SOLE MEMBER / AUTHORIZED OFFICAL) |
Authorized Official Contact | 2487024145 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Grateful Hearts Mihp 19785 W 12 Mile Rd Pmb 553 Southfield MI 48076-2584 Ph: (248) 702-4145 | Grateful Hearts Mihp 18444 W 10 Mile Rd Ste 200 Southfield MI 48075-2626 Ph: (248) 702-4145 |
NPI Number | 1457803306 |
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Provider Enumeration Date | 10/26/2016 |
Last Update Date | 09/25/2024 |
Certification Date | 09/25/2024 |
Medicare PECOS PAC ID | 2860759529 |
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Medicare Enrollment ID | O20171205002035 |
Identifier | Type | State | Issuer |
---|---|---|---|
1457803306 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1041C0700X | Social Worker - Clinical | 6801087468 (Michigan) | Primary |
Provider Name | Beth L Baker |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1740391135 PECOS PAC ID: 1658508924 Enrollment ID: I20131211001484 |
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