Provider Demographics
NPI:1992015341
Name:SMALL TREASURES MATERNAL INFANT HEALTH PROGRAM
Entity type:Organization
Organization Name:SMALL TREASURES MATERNAL INFANT HEALTH PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LA'TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-289-3227
Mailing Address - Street 1:29193 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 692
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1011
Mailing Address - Country:US
Mailing Address - Phone:313-459-1869
Mailing Address - Fax:
Practice Address - Street 1:29193 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 692
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1011
Practice Address - Country:US
Practice Address - Phone:248-289-3227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251300000XAgenciesLocal Education Agency (LEA)