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General NPI Number Information
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NPI Number | 1144180183
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Entity Type | Organization
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Legal Business Name | DYNASTY SENIOR CENTER
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 1021 CLAIRPOINTE ST
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City | DETROIT
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State | MI
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Zip | 48215-2985
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Country | US
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Telephone | 313-214-6855
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Fax |
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Provider Business Mailing Address
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Address Line | 2992 MARLBOROUGH ST
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City | DETROIT
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State | MI
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Zip | 48215-2592
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Country | US
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Telephone | 313-214-6855
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTIAN BOATMON
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Credential |
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Telephone | 313-214-6855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 385H00000X
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Taxonomy Name | Respite Care
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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 | 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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