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General NPI Number Information
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NPI Number | 1659854313
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Entity Type | Organization
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Legal Business Name | KENYATA'S AFC LLC
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Dates
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Enumeration Date | 09/10/2018
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 8136 SIRRON ST
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City | DETROIT
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State | MI
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Zip | 48234-3314
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Country | US
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Telephone | 313-893-5022
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Fax | 313-733-6660
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Provider Business Mailing Address
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Address Line | 19152 CHESHIRE ST
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City | GROSSE POINTE
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State | MI
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Zip | 48236-2012
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Country | US
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Telephone | 313-475-9947
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Fax | 313-733-6660
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. KENYATA HAMILTON-CARTER
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Credential |
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Telephone | 313-475-9947
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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 |
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License Number State |
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