P.E.a.C.E. in Young Life Center, Inc.

Primary specialty

Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X

Legal business name

P.E.A.C.E. IN YOUNG LIFE CENTER, INC.

Practice address

15471 Cloverlawn St
Ste 101
Detroit, MI 48238-1146

Phone

(313) 345-3853

Fax

(313) 345-4358

NPI assigned

Dec 29, 2006

Last updated

Aug 1, 2007By 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

Ms. Marchelle Mitzi Gaines

Title

Ceo

Phone

(313) 220-9033

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Servilla V Harris, LCSW

  • Clinical Social Worker
  • Southfield, MI
  • NPI 1295867174
  NPD (past)

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185926400000",
    "number": "1891851226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15471 CLOVERLAWN ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482381146",
            "telephone_number": "313-345-3853",
            "fax_number": "313-345-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15471 CLOVERLAWN ST",
            "address_2": "STE 101",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482381146",
            "telephone_number": "313-345-3853",
            "fax_number": "313-345-4358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P.E.A.C.E. IN YOUNG LIFE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2007-08-01",
        "status": "A",
        "authorized_official_last_name": "GAINES",
        "authorized_official_first_name": "MARCHELLE",
        "authorized_official_middle_name": "MITZI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "313-220-9033",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Children's Substance Abuse Rehabilitation Facility in Detroit, MI
• Providers in Detroit, MI by specialty
• Children's Substance Abuse Rehabilitation Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2007; 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.