Healthcare Provider Details

I. General information

NPI: 1255841656
Provider Name (Legal Business Name): HARMONY'S HOUSE DAY PROGRAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19743 E 14 MILE RD
CLINTON TOWNSHIP MI
48035-3908
US

IV. Provider business mailing address

19743 E 14 MILE RD
CLINTON TOWNSHIP MI
48035-3908
US

V. Phone/Fax

Practice location:
  • Phone: 586-477-1600
  • Fax: 586-477-1604
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAEL MARIE CHILDRESS
Title or Position: ADMINISTRATOR/PROGRAM COORDINATOR
Credential:
Phone: 313-828-0125