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General NPI Number Information
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NPI Number | 1255667366
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Entity Type | Organization
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Legal Business Name | SALERY AFC
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 7387 KIPLING ST
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City | DETROIT
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State | MI
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Zip | 48206-2624
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Country | US
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Telephone | 131-870-9545
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Fax | 313-870-9541
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Provider Business Mailing Address
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Address Line | PO BOX 34384
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City | DETROIT
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State | MI
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Zip | 48234-0384
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Country | US
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Telephone | 313-870-9545
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Fax | 313-870-9541
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Authorized Official
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Title or Position | HOME PROVIDER
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Name | MR. OSCAR SALERY
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Credential |
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Telephone | 313-702-7386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | AS82094960
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License Number State | MI
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