Healthcare Provider Details

I. General information

NPI: 1629833165
Provider Name (Legal Business Name): CISSERIAC ASSISTED LIVING CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28931 W 11 MILE RD
FARMINGTON HILLS MI
48336-1403
US

IV. Provider business mailing address

23332 FARMINGTON RD # 216
FARMINGTN HLS MI
48336-9991
US

V. Phone/Fax

Practice location:
  • Phone: 313-782-3470
  • Fax:
Mailing address:
  • Phone: 313-782-3470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SARAH KIRONDE
Title or Position: DIRECTOR
Credential:
Phone: 313-782-3470