Rebirth Community Inclusion Program

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

Legal business name

REBIRTH COMMUNITY INCLUSION PROGRAM

Practice address

16951 Maryland St
Southfield, MI 48075-2903

Phone

(313) 418-5667

NPI assigned

Apr 21, 2017

Organization subpart

No

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

Authorized official

Name

Mrs. Linda Teresa Jefferson, MA,LLPC,CCS,CAADC

Title

Chielf Executive Officer

Phone

(313) 418-5667

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• aroma coffeehouse Doing business as

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

{
    "created_epoch": "1492732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1780119214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16951 MARYLAND",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48228",
            "telephone_number": "313-418-5667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16951 MARYLAND ST",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752903",
            "telephone_number": "313-418-5667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REBIRTH COMMUNITY INCLUSION PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-21",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "JEFFERSON",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "TERESA",
        "authorized_official_title_or_position": "CHIELF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "313-418-5667",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA,LLPC,CCS,CAADC"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902926207",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "aroma coffeehouse",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Health Maintenance Organization in Southfield, MI
• Providers in Southfield, MI by specialty
• Health Maintenance Organization in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.