Healthcare Provider Details

I. General information

NPI: 1063328607
Provider Name (Legal Business Name): ANGELIC CARE GROUP HOME- SPECIALIZED AFC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24548 SARGENT AVE
SOUTHFIELD MI
48033-3932
US

IV. Provider business mailing address

24548 SARGENT AVE
SOUTHFIELD MI
48033-3932
US

V. Phone/Fax

Practice location:
  • Phone: 248-403-0689
  • Fax:
Mailing address:
  • Phone: 248-403-0689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TOCHUKWU ANYADIBE
Title or Position: ADMINITRATOR
Credential:
Phone: 248-403-0689