Provider Demographics
NPI:1063786168
Name:ADOLESCENCE IN MOTION
Entity type:Organization
Organization Name:ADOLESCENCE IN MOTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMP-GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-205-3295
Mailing Address - Street 1:237 N OLD WOODWARD AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-5305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:237 N OLD WOODWARD AVE STE 5
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-5305
Practice Address - Country:US
Practice Address - Phone:248-723-7152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children