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General NPI Number Information
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NPI Number | 1104618289
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Entity Type | Individual
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Provider Name | CYNTHA OVERTON
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Gender | Female
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 9225 MCKINNEY ST
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City | DETROIT
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State | MI
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Zip | 48224-2530
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Country | US
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Telephone | 313-587-7084
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Fax |
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Provider Business Mailing Address
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Address Line | 9225 MCKINNEY ST
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City | DETROIT
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State | MI
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Zip | 48224-2530
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Country | US
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Telephone | 313-587-7084
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #5
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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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