Basic Information
| Provider Information | |||||||||
| NPI: | 1205854916 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DETROIT EAST, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11457 SHOEMAKER ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482133418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133313435 | ||||||||
| FaxNumber: | 3139214125 | ||||||||
| Practice Location | |||||||||
| Address1: | 11457 SHOEMAKER ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482133418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133313435 | ||||||||
| FaxNumber: | 3139214125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SNOWDEN | ||||||||
| AuthorizedOfficialFirstName: | MARILYN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3133313435 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QR0405X | X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.