Healthcare Provider Details

I. General information

NPI: 1376214437
Provider Name (Legal Business Name): SL CARE ADVOCACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 11/26/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 N MAIN ST
ROYAL OAK MI
48067-1813
US

IV. Provider business mailing address

PO BOX 1032
ROYAL OAK MI
48068-1032
US

V. Phone/Fax

Practice location:
  • Phone: 248-571-0200
  • Fax:
Mailing address:
  • Phone: 248-710-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: QEYATA MCCOY
Title or Position: ADMINISTRATOR
Credential: ABA CBRM, LPN
Phone: 248-710-4393