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General NPI Number Information
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NPI Number | 1720953896
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Entity Type | Organization
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Legal Business Name | FAITH DRIVEN ADULT DAY CARE, LLC
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Dates
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Enumeration Date | 10/08/2025
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 21009 ITHACA AVE
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City | FERNDALE
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State | MI
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Zip | 48220-2139
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Country | US
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Telephone | 313-806-7075
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4210
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City | SOUTHFIELD
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State | MI
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Zip | 48037-4210
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Country | US
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Telephone | 313-806-7075
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEJA VASQUEZ
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Credential | ESQ
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Telephone | 313-806-7075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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