| Missionary Servants Of Divine Providence | |
|
26629 Hopkins St Inkster MI 48141-3111 | |
| (734) 560-5014 | |
| (313) 633-9510 |
| Full Name | Missionary Servants Of Divine Providence |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 26629 Hopkins St, Inkster, Michigan |
| Authorized Official Name and Position | Justina E Udeagha (ADMINISTRATOR/ DIRECTOR) |
| Authorized Official Contact | 7345605014 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Missionary Servants Of Divine Providence 4101 Moore St Inkster MI 48141-3017 Ph: (734) 560-5014 | Missionary Servants Of Divine Providence 26629 Hopkins St Inkster MI 48141-3111 Ph: (734) 560-5014 |
| NPI Number | 1073062725 |
|---|---|
| Provider Enumeration Date | 09/22/2016 |
| Last Update Date | 03/08/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073062725 | NPI | - | NPPES |
| 1578772240 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6801084613 (Michigan) | Secondary |
| 251S00000X | Community/behavioral Health | 6801084613 (Michigan) | Primary |
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