=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194688077
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AFRIKA MOONYEEN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2025
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8210 AUBURN ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48228-2915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-778-2559
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16221 GRAND RIVER AVE
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48227-1823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-406-4029
-----------------------------------------------------
Fax | 313-406-4029
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AFRIKA JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-785-7501
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------