Healthcare Provider Details

I. General information

NPI: 1134258577
Provider Name (Legal Business Name): HYFS HERE FOR YOUR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15146 GRAYFIELD ST
DETROIT MI
48223-1822
US

IV. Provider business mailing address

15146 GRAYFIELD ST
DETROIT MI
48223-1822
US

V. Phone/Fax

Practice location:
  • Phone: 313-720-2563
  • Fax: 313-543-9328
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberS516765135111
License Number StateMI

VIII. Authorized Official

Name: DAMIEN SANFORD
Title or Position: COORDINATOR
Credential:
Phone: 313-720-2563