Provider Demographics
NPI:1174374797
Name:SOUL FORWARD SOBER COMPANIONS
Entity type:Organization
Organization Name:SOUL FORWARD SOBER COMPANIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:586-339-2178
Mailing Address - Street 1:133 E GRAND BLVD APT 208
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-3777
Mailing Address - Country:US
Mailing Address - Phone:586-339-2178
Mailing Address - Fax:
Practice Address - Street 1:4000 TOWN CTR STE 1303
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1410
Practice Address - Country:US
Practice Address - Phone:248-932-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty