Provider Demographics
NPI:1366809519
Name:PAMPERED CHILD
Entity type:Organization
Organization Name:PAMPERED CHILD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:SHAKIR
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:248-210-9466
Mailing Address - Street 1:1450 OAKBROOK E
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1126
Mailing Address - Country:US
Mailing Address - Phone:248-210-9466
Mailing Address - Fax:
Practice Address - Street 1:44200 WOODWARD AVE
Practice Address - Street 2:STE 205
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5045
Practice Address - Country:US
Practice Address - Phone:248-210-9466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care