| NPI | 1922856558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORA DAVIS Administrator/Owner 313-590-9139 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 253J00000X Foster Care Agency |
| 310400000X Assisted Living Facility | |
| 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness | |
| 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances | |
| 310500000X Intermediate Care Facility, Mental Illness | |
| 311500000X Alzheimer Center (Dementia Center) | |
| 311Z00000X Custodial Care Facility | |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities | |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| 385H00000X Respite Care | |
| Enumeration Date | 2024-05-08 |
| Last Update Date | 2024-05-08 |