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General NPI Number Information
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NPI Number | 1609209634
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Entity Type | Organization
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Legal Business Name | DETROIT FAMILY HOME
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 12/22/2017
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Provider Practice Location Address
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Address Line | 17180 INDIANA ST
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City | DETROIT
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State | MI
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Zip | 48221-2445
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Country | US
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Telephone | 313-270-7751
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Fax | 313-270-7291
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Provider Business Mailing Address
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Address Line | 17180 INDIANA ST
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City | DETROIT
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State | MI
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Zip | 48221-2445
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Country | US
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Telephone | 313-270-7751
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Fax | 313-270-7291
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Authorized Official
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Title or Position | CEO
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Name | MR. JEAN FELIX NYAMBIO
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Credential | CRNA
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Telephone | 301-332-3009
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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 | AS820338244
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AS820338244
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License Number State | MI
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Taxonomy #3
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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 | AS820338244
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | AS820338244
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | AS820338244
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | AS820338244
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License Number State | MI
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Taxonomy #7
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | AS820338244
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License Number State | MI
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