Healthcare Provider Details

I. General information

NPI: 1689512899
Provider Name (Legal Business Name): BIRDIE MAE'S BRUNCH BAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6381 W OUTER DR
DETROIT MI
48235-2719
US

IV. Provider business mailing address

6381 W OUTER DR
DETROIT MI
48235-2719
US

V. Phone/Fax

Practice location:
  • Phone: 248-605-1516
  • Fax:
Mailing address:
  • Phone: 248-605-1516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: CIERRA MCFARLIN
Title or Position: OWNER
Credential:
Phone: 248-605-1516