Provider Demographics
NPI:1124325964
Name:P O W E R PEOPLE ORGANIZED WORKING EVOLVING REACHING
Entity type:Organization
Organization Name:P O W E R PEOPLE ORGANIZED WORKING EVOLVING REACHING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:V
Authorized Official - Last Name:BURRELL-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LMSW
Authorized Official - Phone:734-961-1990
Mailing Address - Street 1:301 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5450
Mailing Address - Country:US
Mailing Address - Phone:734-961-1990
Mailing Address - Fax:734-961-1996
Practice Address - Street 1:301 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5450
Practice Address - Country:US
Practice Address - Phone:734-961-1990
Practice Address - Fax:734-961-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1184818700251S00000X
MI1447450226251S00000X, 251B00000X
6801035881251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP146711OtherBCBS ID #
MIMI5563Medicare PIN