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General NPI Number Information
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NPI Number | 1033095237
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Entity Type | Organization
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Legal Business Name | KONI'S AFC HOME
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 369 VOORHEIS ST
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City | PONTIAC
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State | MI
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Zip | 48341-1949
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Country | US
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Telephone | 248-396-2973
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Fax |
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Provider Business Mailing Address
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Address Line | 369 VOORHEIS ST
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City | PONTIAC
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State | MI
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Zip | 48341-1949
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ROZA TESFAYE
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Credential |
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Telephone | 248-396-2973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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