Healthcare Provider Details

I. General information

NPI: 1184803678
Provider Name (Legal Business Name): DIANES SWEET HOME,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 CARPENTER RD
YPSILANTI MI
48197-8847
US

IV. Provider business mailing address

7750 CARPENTER RD POBOX981102
YPSILANTI MI
48197-8847
US

V. Phone/Fax

Practice location:
  • Phone: 734-528-9881
  • Fax:
Mailing address:
  • Phone: 734-528-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateMI

VIII. Authorized Official

Name: MRS. GERALDINE FITCH
Title or Position: ADMINSTRATOR
Credential: BSW
Phone: 734-528-9881