Basic Information
| Provider Information | |||||||||
| NPI: | 1831384338 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY WORK OPPORTUNITIES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32231 SCHOOLCRAFT RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481504312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344588140 | ||||||||
| FaxNumber: | 7344587935 | ||||||||
| Practice Location | |||||||||
| Address1: | 5900 N LILLEY RD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481873776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349813709 | ||||||||
| FaxNumber: | 7349815384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2007 | ||||||||
| LastUpdateDate: | 07/30/2011 | ||||||||
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| AuthorizedOfficialLastName: | BOISVENU | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7344588140 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | QUEST, INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251V00000X | N | Agencies | Voluntary or Charitable | 261QX0100X | N | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine | 343900000X | N | Transportation Services | Non-emergency Medical Transport (VAN) | 347C00000X | N | Transportation Services | Private Vehicle | 251S00000X | N | Agencies | Community/Behavioral Health | 261QD1600X | N | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | 251C00000X | Y | Agencies | Day Training, Developmentally Disabled Services |
No ID Information.