Healthcare Provider Details

I. General information

NPI: 1417355132
Provider Name (Legal Business Name): TRUE AGAPE ADULT PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E STATE FAIR
DETROIT MI
48203-1258
US

IV. Provider business mailing address

1500 E STATE FAIR
DETROIT MI
48203-1258
US

V. Phone/Fax

Practice location:
  • Phone: 313-974-9953
  • Fax: 947-282-8999
Mailing address:
  • Phone: 313-974-9953
  • Fax: 947-282-8999

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: CHARLOTTE L BENNETT
Title or Position: DIRECTOR
Credential: R.N.
Phone: 313-974-9953