Missionary Servants of Divine Providence

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

6801084613 Issued in MI

Legal business name

MISSIONARY SERVANTS OF DIVINE PROVIDENCE

Practice address

26629 Hopkins St
Inkster, MI 48141-3111

Phone

(734) 560-5014

Fax

(313) 633-9510

NPI assigned

Sep 22, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Justina E Udeagha

Title

Administrator/ Director

Phone

(734) 560-5014

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488931200000",
    "number": "1073062725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 MOORE ST",
            "city": "INKSTER",
            "state": "MI",
            "postal_code": "481413017",
            "telephone_number": "734-560-5014",
            "fax_number": "313-633-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26629 HOPKINS ST",
            "city": "INKSTER",
            "state": "MI",
            "postal_code": "481413111",
            "telephone_number": "734-560-5014",
            "fax_number": "313-633-9510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSIONARY SERVANTS OF DIVINE PROVIDENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-22",
        "last_updated": "2017-03-08",
        "status": "A",
        "authorized_official_last_name": "UDEAGHA",
        "authorized_official_first_name": "JUSTINA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR/ DIRECTOR",
        "authorized_official_telephone_number": "734-560-5014"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801084613",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MI",
            "license": "6801084613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1578772240",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ava Mignon Miller
• Erika Miller
• Milqcare
• Claire Minneboo
• Missionary Daughters of the Eternal Father
• Missionary Servants of Divine Providence
• Euneika Sade Mitchell
• Ahmed Mohamed
• Cherice Moore
• Lache Moore, CHW

• Community/Behavioral Health Agency in Inkster, MI
• Providers in Inkster, MI by specialty
• Community/Behavioral Health Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.