Provider Demographics
NPI:1316244965
Name:Y.A.D.
Entity type:Organization
Organization Name:Y.A.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BLANCHE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-729-4547
Mailing Address - Street 1:PO BOX 13185
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-0185
Mailing Address - Country:US
Mailing Address - Phone:313-729-4547
Mailing Address - Fax:313-821-8683
Practice Address - Street 1:18425 HICKORY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-2707
Practice Address - Country:US
Practice Address - Phone:313-729-4547
Practice Address - Fax:313-821-8683
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMMANUEL HOUSE 1&2 INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QA0600X261QA0600X
MI261QR0405X261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2387424Medicaid