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General NPI Number Information
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NPI Number | 1023998630
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Entity Type | Organization
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Legal Business Name | ASSISTED LIVING SUPPORT SERVICE LLC
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 5898 GLENWOOD DR
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City | CANTON
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State | MI
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Zip | 48187-0030
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Country | US
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Telephone | 734-883-3370
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Fax |
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Provider Business Mailing Address
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Address Line | 5898 GLENWOOD DR
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City | CANTON
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State | MI
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Zip | 48187-0030
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Country | US
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Telephone | 734-883-3370
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PATIENT SERVICE
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Name | HODON O FARAH
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Credential |
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Telephone | 734-883-3370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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