Provider Demographics
NPI:1942538533
Name:CHILDREN'S HOPE SERVICES INC.
Entity type:Organization
Organization Name:CHILDREN'S HOPE SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-252-8806
Mailing Address - Street 1:PO BOX 725123
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-5123
Mailing Address - Country:US
Mailing Address - Phone:248-252-8806
Mailing Address - Fax:248-569-5252
Practice Address - Street 1:15700 W 10 MILE RD
Practice Address - Street 2:SUITE 215
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2149
Practice Address - Country:US
Practice Address - Phone:248-252-8806
Practice Address - Fax:248-443-5799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801083977101YM0800X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty