Mentors of Michigan Inc.

Primary specialty

Foster Care AgencyTaxonomy code 253J00000X

License

AS630273674 Issued in MI

Legal business name

MENTORS OF MICHIGAN INC.

Practice address

10140 Curtis LN
White Lake, MI 48386-3813

Phone

(248) 360-1714

NPI assigned

Sep 14, 2017

Last updated

Sep 14, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kelly Ann Devereaux

Title

President

Phone

(248) 632-3534

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1505347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505347200000",
    "number": "1447779061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3812 FINCH DR",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480841667",
            "telephone_number": "248-632-3534",
            "fax_number": "248-269-7167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10140 CURTIS LN",
            "city": "WHITE LAKE",
            "state": "MI",
            "postal_code": "483863813",
            "telephone_number": "248-360-1714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTORS OF MICHIGAN INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-14",
        "last_updated": "2017-09-14",
        "status": "A",
        "authorized_official_last_name": "DEVEREAUX",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-632-3534"
    },
    "taxonomies": [
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": "MI",
            "license": "AS630273674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Foster Care Agency in White Lake, MI
• Providers in White Lake, MI by specialty
• Foster Care Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.