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General NPI Number Information
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NPI Number | 1386947299
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Entity Type | Organization
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Legal Business Name | FAITH AFC INC
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 30440 OLD STREAM ST
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City | SOUTHFIELD
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State | MI
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Zip | 48076-1098
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Country | US
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Telephone | 248-433-1261
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 273
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City | SOUTHFIELD
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State | MI
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Zip | 48037-0273
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Country | US
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Telephone | 248-433-1261
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Fax |
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Authorized Official
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Title or Position | ADMINISTRTOR
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Name | MRS. NIKEISHA BROWN
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Credential |
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Telephone | 313-529-8808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | AS8202384444
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | AS820238444
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License Number State | MI
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