| Goddess Great | |
|
17169 E Warren Ave Detroit MI 48224-2279 | |
| (313) 856-9192 | |
| Not Available |
| Full Name | Goddess Great |
|---|---|
| Speciality | Case Management |
| Location | 17169 E Warren Ave, Detroit, Michigan |
| Authorized Official Name and Position | Kymaletha Brown (COORDINATOR) |
| Authorized Official Contact | 2694145907 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Goddess Great 10728 Duprey St Detroit MI 48224-1295 Ph: (269) 414-5907 | Goddess Great 17169 E Warren Ave Detroit MI 48224-2279 Ph: (313) 856-9192 |
| NPI Number | 1104435460 |
|---|---|
| Provider Enumeration Date | 07/23/2020 |
| Last Update Date | 01/20/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104435460 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 251B00000X | Case Management | (* (Not Available)) | Primary |
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