NPI 1174866610

Mabel Avenue Home

Organisation Exclusive Provider Organization Flint, MI

Practice location

Address: 1446 Mabel Ave, Flint, MI 48506-3343
Phone: (810) 820-7279
Fax: (810) 820-7279

Authorised official

Name: Mary Ann Lewis
Title: Owner
Phone: (810) 820-7279

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence AS250337649 (MI)

Other Exclusive Provider Organization providers in Michigan →

Registry record

NPI: 1174866610
Entity type: Organization
NPI issued: 3 Apr 2013
Record last updated: 3 Apr 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.