Healthcare Provider Details

I. General information

NPI: 1477083871
Provider Name (Legal Business Name): GRACE BY FAITH SENIOR CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 06/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 E JEFFERSON AVE
DETROIT MI
48214-3320
US

IV. Provider business mailing address

11200 E JEFFERSON AVE
DETROIT MI
48214-3320
US

V. Phone/Fax

Practice location:
  • Phone: 586-738-8752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: CHERYL COLEMAN-BROWN
Title or Position: OWNER
Credential:
Phone: 586-738-8752