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General NPI Number Information
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NPI Number | 1174901250
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Entity Type | Organization
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Legal Business Name | FIRST LADIES HOME
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 05/11/2015
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Provider Practice Location Address
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Address Line | 3626 HARRIET ST
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City | INKSTER
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State | MI
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Zip | 48141-2977
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Country | US
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Telephone | 734-398-1159
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Fax |
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Provider Business Mailing Address
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Address Line | 7730 KIRKRIDGE ST
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City | BELLEVILLE
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State | MI
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Zip | 48111-1627
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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 | LICENSEE
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Name | LASHANA NEWMAN
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Credential |
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Telephone | 313-978-0499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AS820366079
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License Number State | MI
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