Provider Demographics
NPI:1104100411
Name:KATHY'S MATERNAL INFANT HEALTH PROGRAM
Entity type:Organization
Organization Name:KATHY'S MATERNAL INFANT HEALTH PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ANITA
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LLBSW
Authorized Official - Phone:248-320-6992
Mailing Address - Street 1:18446 WESTHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4119
Mailing Address - Country:US
Mailing Address - Phone:248-320-6992
Mailing Address - Fax:866-396-4055
Practice Address - Street 1:18446 WESTHAVEN AVE
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4119
Practice Address - Country:US
Practice Address - Phone:248-320-6992
Practice Address - Fax:866-396-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802085964251B00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management