Provider Demographics
NPI:1124491170
Name:INSTITUTE OF SUPPORTIVE SERVICES, INC.
Entity type:Organization
Organization Name:INSTITUTE OF SUPPORTIVE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MS/P, CCS, SST, CADC
Authorized Official - Phone:313-948-8630
Mailing Address - Street 1:12400 E 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2155
Mailing Address - Country:US
Mailing Address - Phone:313-948-8630
Mailing Address - Fax:313-345-3755
Practice Address - Street 1:12400 E 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-2155
Practice Address - Country:US
Practice Address - Phone:313-948-8630
Practice Address - Fax:313-345-3755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone