Provider Demographics
NPI:1699471078
Name:SOCIALLY CONNECTED LLC
Entity type:Organization
Organization Name:SOCIALLY CONNECTED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MERA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-575-6884
Mailing Address - Street 1:35211 FORD RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-3172
Mailing Address - Country:US
Mailing Address - Phone:313-575-6884
Mailing Address - Fax:
Practice Address - Street 1:35211 FORD RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3172
Practice Address - Country:US
Practice Address - Phone:313-575-6884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty