Healthcare Provider Details

I. General information

NPI: 1992128110
Provider Name (Legal Business Name): LOVING HANDS ADULT DAY CARE&THERAPEUTIC CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 S PATRICIA ST
DETROIT MI
48217-1230
US

IV. Provider business mailing address

1056 S PATRICIA ST
DETROIT MI
48217-1230
US

V. Phone/Fax

Practice location:
  • Phone: 313-544-0731
  • Fax: 313-849-2763
Mailing address:
  • Phone: 313-544-0731
  • Fax: 313-849-2763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. TERENCE DALE WOOLFORK
Title or Position: CEO
Credential:
Phone: 313-544-0731