Provider Demographics
NPI:1053736363
Name:EMPOWERMENT ZONE COALITION, INC.
Entity type:Organization
Organization Name:EMPOWERMENT ZONE COALITION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TURK-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CHES, CPC-M
Authorized Official - Phone:313-921-9403
Mailing Address - Street 1:4146 LAKEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2306
Mailing Address - Country:US
Mailing Address - Phone:313-921-9403
Mailing Address - Fax:313-921-9412
Practice Address - Street 1:4146 LAKEWOOD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2306
Practice Address - Country:US
Practice Address - Phone:313-921-9403
Practice Address - Fax:313-921-9412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI822149OtherSUBSTANCE ABUSE PREVENTION LICENSE