Healthcare Provider Details

I. General information

NPI: 1518324953
Provider Name (Legal Business Name): NEW FAITH ADULT DAY PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34012 PAWNEE ST
WESTLAND MI
48185-2706
US

IV. Provider business mailing address

34012 PAWNEE ST
WESTLAND MI
48185-2706
US

V. Phone/Fax

Practice location:
  • Phone: 734-301-7960
  • Fax:
Mailing address:
  • Phone: 734-301-7960
  • Fax:

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: MRS. LASEAN FLEMING
Title or Position: OWNER
Credential:
Phone: 734-301-7960