Healthcare Provider Details

I. General information

NPI: 1538241211
Provider Name (Legal Business Name): ROSEBERRY ADULT FOSTER CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7161 PALMETTO ST
DETROIT MI
48234-4166
US

IV. Provider business mailing address

PO BOX 34225
DETROIT MI
48234-0225
US

V. Phone/Fax

Practice location:
  • Phone: 313-282-9083
  • Fax:
Mailing address:
  • Phone: 313-282-9083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateMI

VIII. Authorized Official

Name: BARBARA ROSEBERRY
Title or Position: PROVIDER
Credential:
Phone: 313-282-9083