Healthcare Provider Details

I. General information

NPI: 1386947299
Provider Name (Legal Business Name): FAITH AFC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30440 OLD STREAM ST
SOUTHFIELD MI
48076-1098
US

IV. Provider business mailing address

PO BOX 273
SOUTHFIELD MI
48037-0273
US

V. Phone/Fax

Practice location:
  • Phone: 248-433-1261
  • Fax:
Mailing address:
  • Phone: 248-433-1261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberAS820238444
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberAS8202384444
License Number StateMI

VIII. Authorized Official

Name: MRS. NIKEISHA BROWN
Title or Position: ADMINISTRTOR
Credential:
Phone: 313-529-8808