Healthcare Provider Details

I. General information

NPI: 1194365320
Provider Name (Legal Business Name): VILLAGE OF HOPE ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E GRAND BLVD
DETROIT MI
48207-3636
US

IV. Provider business mailing address

511 E GRAND BLVD
DETROIT MI
48207-3636
US

V. Phone/Fax

Practice location:
  • Phone: 248-750-7739
  • Fax: 313-725-9493
Mailing address:
  • Phone: 248-750-7739
  • Fax: 313-725-9493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONTRAIL MCCORD
Title or Position: OWNER
Credential:
Phone: 248-750-7739