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General NPI Number Information
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NPI Number | 1053879718
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Entity Type | Organization
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Legal Business Name | ALTERNATIVE ADULT RESIDENCE INC.
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 18403 KENTUCKY ST
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City | DETROIT
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State | MI
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Zip | 48221-2029
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Country | US
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Telephone | 313-334-1953
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Fax |
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Provider Business Mailing Address
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Address Line | 29350 MARIMOOR DR
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City | SOUTHFIELD
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State | MI
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Zip | 48076-1615
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Country | US
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Telephone | 313-215-2303
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADRIENNE FLOWERS
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Credential |
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Telephone | 313-334-1953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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