Healthcare Provider Details

I. General information

NPI: 1194688077
Provider Name (Legal Business Name): AFRIKA MOONYEEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 AUBURN ST
DETROIT MI
48228-2915
US

IV. Provider business mailing address

16221 GRAND RIVER AVE
DETROIT MI
48227-1823
US

V. Phone/Fax

Practice location:
  • Phone: 313-778-2559
  • Fax:
Mailing address:
  • Phone: 313-406-4029
  • Fax: 313-406-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: AFRIKA JOHNSON
Title or Position: OWNER
Credential:
Phone: 248-785-7501