Provider Demographics
NPI:1336988567
Name:PELLE'S COMMUNITY EMPOWERMENT
Entity type:Organization
Organization Name:PELLE'S COMMUNITY EMPOWERMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUND/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHENICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-508-0775
Mailing Address - Street 1:16434 CONSTANCE AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-4311
Mailing Address - Country:US
Mailing Address - Phone:248-508-0775
Mailing Address - Fax:
Practice Address - Street 1:16434 CONSTANCE AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-4311
Practice Address - Country:US
Practice Address - Phone:248-508-0775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care