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General NPI Number Information
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NPI Number | 1013806199
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Entity Type | Organization
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Legal Business Name | G & G HOME ENTERPRISE LLC
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 8710 W DAVISON
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City | DETROIT
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State | MI
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Zip | 48238-3002
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Country | US
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Telephone | 313-307-1090
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Fax |
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Provider Business Mailing Address
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Address Line | 9099 POTTERVILLE DR
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City | WILLIS
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State | MI
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Zip | 48191-9504
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Country | US
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Telephone | 313-888-4552
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MS. GABRIEL ELDER
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Credential |
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Telephone | 313-888-4552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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