Healthcare Provider Details

I. General information

NPI: 1316034929
Provider Name (Legal Business Name): HANCOCK RESIDENTIAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W WILLIS ST
DETROIT MI
48201-1629
US

IV. Provider business mailing address

801 W WILLIS ST
DETROIT MI
48201-1629
US

V. Phone/Fax

Practice location:
  • Phone: 313-831-3551
  • Fax: 313-831-8718
Mailing address:
  • Phone: 313-831-3551
  • Fax: 313-831-8718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. FREDERICK T FELDER
Title or Position: ACCOUNTANT
Credential:
Phone: 248-538-9100