Healthcare Provider Details

I. General information

NPI: 1982383196
Provider Name (Legal Business Name): ACTIVATING TRANSITIONS CAREGIVERS AND COMPANIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 HILL ST
RIVER ROUGE MI
48218-1537
US

IV. Provider business mailing address

58 HILL ST
RIVER ROUGE MI
48218-1537
US

V. Phone/Fax

Practice location:
  • Phone: 313-828-2058
  • Fax:
Mailing address:
  • Phone: 313-828-2058
  • Fax: 313-828-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: MS. LATISHA BLACKWELL
Title or Position: OWNER/EXECUTIVE DIRECTOR
Credential:
Phone: 313-138-2820