Healthcare Provider Details

I. General information

NPI: 1902448731
Provider Name (Legal Business Name): SIMEON'S REST ADULT DAY PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46500 N TERRITORIAL RD
PLYMOUTH MI
48170-3066
US

IV. Provider business mailing address

46500 N TERRITORIAL RD
PLYMOUTH MI
48170-3066
US

V. Phone/Fax

Practice location:
  • Phone: 734-207-9673
  • Fax:
Mailing address:
  • Phone: 734-560-5872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. GRACE D. HOLNESS
Title or Position: DIRECTOR
Credential: B/A OF SCIENCE
Phone: 734-560-5872