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General NPI Number Information
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NPI Number | 1356636427
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Entity Type | Organization
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Legal Business Name | HIDDEN PEACE SPECIALIZED LIVING SERVICES, INC.
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 10520 HARTLAND RD
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City | FENTON
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State | MI
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Zip | 48430-8704
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Country | US
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Telephone | 810-629-8647
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Fax | 810-629-8839
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Provider Business Mailing Address
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Address Line | 10520 HARTLAND RD
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City | FENTON
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State | MI
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Zip | 48430-8704
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Country | US
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Telephone | 810-629-8647
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Fax | 810-629-8839
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KAREN LEE RUSSELL
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Credential |
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Telephone | 810-629-8647
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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 | AF470301064
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License Number State | MI
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