Healthcare Provider Details

I. General information

NPI: 1528569209
Provider Name (Legal Business Name): MICHIGAN ADULT EMPOWERMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19309 GREENFIELD RD
DETROIT MI
48235-2004
US

IV. Provider business mailing address

25681 CODE RD
SOUTHFIELD MI
48033-5813
US

V. Phone/Fax

Practice location:
  • Phone: 313-300-7177
  • Fax:
Mailing address:
  • Phone: 313-300-7177
  • 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: MR. TITO TIMMONS BENTLEY
Title or Position: OWNER
Credential:
Phone: 313-300-7177