Healthcare Provider Details

I. General information

NPI: 1376633297
Provider Name (Legal Business Name): ANGELS' PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29299 FRANKLIN ROAD #2
SOUTHFIELD MI
48034
US

IV. Provider business mailing address

29299 FRANKLIN ROAD #2
SOUTHFIELD MI
48034
US

V. Phone/Fax

Practice location:
  • Phone: 248-350-2203
  • Fax: 248-350-3577
Mailing address:
  • Phone: 248-350-2203
  • Fax: 248-350-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberAS820244249
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberAS630247482
License Number StateMI

VIII. Authorized Official

Name: MS. CHERYL LEE LOVEDAY
Title or Position: EXECUTIVE DIRECTOR
Credential: B.S.
Phone: 248-350-2203