Healthcare Provider Details

I. General information

NPI: 1285122325
Provider Name (Legal Business Name): MIDTOWN ADULT DAY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7436 WOODWARD AVE
DETROIT MI
48202-3100
US

IV. Provider business mailing address

5685 WESTPOINT ST
DEARBORN HEIGHTS MI
48125-2351
US

V. Phone/Fax

Practice location:
  • Phone: 248-910-4663
  • Fax: 313-633-0585
Mailing address:
  • Phone: 248-910-4663
  • Fax: 313-633-0585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: MISS PORCHIA DURANT
Title or Position: CEO
Credential:
Phone: 248-910-4663