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General NPI Number Information
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NPI Number | 1487920021
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Entity Type | Organization
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Legal Business Name | ABIDING LOVE I LLC
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 31641 WIXSON DR
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City | WARREN
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State | MI
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Zip | 48092-5015
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Country | US
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Telephone | 586-693-0736
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Fax | 586-693-0736
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Provider Business Mailing Address
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Address Line | 31641 WIXSON DR
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City | WARREN
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State | MI
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Zip | 48092-5015
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Country | US
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Telephone | 586-693-0736
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Fax | 586-693-0736
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Authorized Official
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Title or Position | LICENSEE DESIGNEE
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Name | MRS. MARIA BELINDA YUMENA
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Credential |
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Telephone | 586-693-0736
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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 | AS500306796
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License Number State | MI
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