Healthcare Provider Details

I. General information

NPI: 1649730243
Provider Name (Legal Business Name): MRS. KISHA FRILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 WOODWARD AVE
DETROIT MI
48202-2142
US

IV. Provider business mailing address

400 RENAISSANCE CTR STE 2600
DETROIT MI
48243-1599
US

V. Phone/Fax

Practice location:
  • Phone: 313-875-8601
  • Fax:
Mailing address:
  • Phone: 888-922-2843
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: