Healthcare Provider Details

I. General information

NPI: 1821506072
Provider Name (Legal Business Name): FREDERICKS FAMILY HOMES AFC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14705 ALLEN RD
SOUTHGATE MI
48195-2552
US

IV. Provider business mailing address

14705 ALLEN RD
SOUTHGATE MI
48195-2552
US

V. Phone/Fax

Practice location:
  • Phone: 734-287-8982
  • Fax:
Mailing address:
  • Phone: 734-287-8982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: SHERYL ANN ALLES
Title or Position: CEO
Credential: PROVIDER
Phone: 734-330-6400