Execu-Tech Manor

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

L796463 Issued in MI

Legal business name

EXECU-TECH MANOR

Practice address

2751 E Jefferson Ave
Suite 500
Detroit, MI 48207-4180

Phone

(313) 396-0100

Fax

(313) 396-0105

NPI assigned

Oct 28, 2006

Organization subpart

No

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

Authorized official

Name

Joseph A Cummings, LMSW,CGP

Title

Executive Director

Phone

(313) 396-0100

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1161993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366528747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2751 E JEFFERSON AVE",
            "address_2": "SUITE 500",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482074180",
            "telephone_number": "313-396-0100",
            "fax_number": "313-396-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2751 E JEFFERSON AVE",
            "address_2": "SUITE 500",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482074180",
            "telephone_number": "313-396-0100",
            "fax_number": "313-396-0105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECU-TECH MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CUMMINGS",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "313-396-0100",
        "authorized_official_credential": "LMSW,CGP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MI",
            "license": "L796463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Detroit, MI
• Providers in Detroit, 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 Aug 22, 2020; 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.