Healthcare Provider Details

I. General information

NPI: 1245705250
Provider Name (Legal Business Name): PEACEFUL HEARTS ADULT DAY CARE 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19115 W 7 MILE RD
DETROIT MI
48219-2706
US

IV. Provider business mailing address

19115 W 7 MILE RD
DETROIT MI
48219-2706
US

V. Phone/Fax

Practice location:
  • Phone: 313-646-9441
  • Fax:
Mailing address:
  • Phone: 313-646-9441
  • 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: EBONY HARVEY-JACKSON
Title or Position: OWNER
Credential: LMSW
Phone: 313-215-6395