Healthcare Provider Details

I. General information

NPI: 1447346374
Provider Name (Legal Business Name): INNER PEACE AFC HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20283 LANCASTER ST
HARPER WOODS MI
48225-1631
US

IV. Provider business mailing address

20283 LANCASTER ST
HARPER WOODS MI
48225-1631
US

V. Phone/Fax

Practice location:
  • Phone: 313-885-4206
  • Fax: 313-499-5483
Mailing address:
  • Phone: 313-885-4206
  • Fax: 313-499-5483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateMI

VIII. Authorized Official

Name: MISS SHARMAN WORTHY
Title or Position: HOME PROVIDER
Credential:
Phone: 313-885-4206