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General NPI Number Information
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NPI Number | 1578935011
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Entity Type | Organization
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Legal Business Name | NEW KEYS TO LIFE SPECIALIZE CARE HOME CARE
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Dates
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Enumeration Date | 10/23/2015
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Last Update Date | 10/23/2015
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Provider Practice Location Address
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Address Line | 115 LAKE VILLAGE BLVD
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City | DEARBORN
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State | MI
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Zip | 48120-1665
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Country | US
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Telephone | 313-422-5183
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Fax |
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Provider Business Mailing Address
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Address Line | 115 LAKE VILLAGE BLVD
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City | DEARBORN
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State | MI
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Zip | 48120-1665
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Country | US
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Telephone | 313-422-5183
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LASHAWN DAVIS
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Credential |
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Telephone | 313-422-5183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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