Provider Demographics
NPI:1306261789
Name:CHARLOTTE'S CARE
Entity type:Organization
Organization Name:CHARLOTTE'S CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEAD SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOWANDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DANCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-719-9990
Mailing Address - Street 1:465 PLUM ST
Mailing Address - Street 2:1605 FORT PARK
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-6553
Mailing Address - Country:US
Mailing Address - Phone:734-285-1143
Mailing Address - Fax:734-285-2789
Practice Address - Street 1:465 PLUM ST
Practice Address - Street 2:1605 FORT PARK
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-6553
Practice Address - Country:US
Practice Address - Phone:734-285-1143
Practice Address - Fax:734-285-2789
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLOTTE'S CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820256000320900000X
MIAS820014266320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities