Healthcare Provider Details

I. General information

NPI: 1295357143
Provider Name (Legal Business Name): AH YPSILANTI SUBTENANT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3470 CARPENTER RD
YPSILANTI MI
48197-9677
US

IV. Provider business mailing address

3470 CARPENTER RD
YPSILANTI MI
48197-9677
US

V. Phone/Fax

Practice location:
  • Phone: 734-677-0071
  • Fax: 734-677-0113
Mailing address:
  • Phone: 734-677-0071
  • Fax: 734-677-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: TERI THORNTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 734-677-0071