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General NPI Number Information
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NPI Number | 1518251008
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Entity Type | Organization
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Legal Business Name | ETNICITY LLC
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 22339 HAMPTON COURT JOYCE HEARD
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City | SOUTHFIELD
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State | MI
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Zip | 48034-2123
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Country | US
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Telephone | 313-310-9241
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Fax | 248-327-7713
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Provider Business Mailing Address
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Address Line | 22339 HAMPTON COURT JOYCE HEARD
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City | SOUTHFIELD
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State | MI
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Zip | 48034
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Country | US
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Telephone | 313-310-9241
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Fax | 248-327-7713
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Authorized Official
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Title or Position | OWNER
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Name | MS. JOYCE ANN HEARD
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Credential | RN
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Telephone | 313-310-9241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State | MI
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