Healthcare Provider Details

I. General information

NPI: 1295381150
Provider Name (Legal Business Name): FMC HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35115 E MICHIGAN AVE
WAYNE MI
48184-1660
US

IV. Provider business mailing address

35115 E MICHIGAN AVE
WAYNE MI
48184-1660
US

V. Phone/Fax

Practice location:
  • Phone: 313-999-4890
  • Fax: 248-615-3047
Mailing address:
  • Phone: 313-999-4890
  • Fax: 248-615-3047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PHYLLIS CLARK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 248-615-3042