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General NPI Number Information
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NPI Number | 1851289862
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Entity Type | Organization
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Legal Business Name | FAVORSIDE COMMUNITY LIVING HOMES, LLC
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 9116 GRAYFIELD
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City | REDFORD
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State | MI
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Zip | 48239-1132
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Country | US
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Telephone | 313-682-6370
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Fax |
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Provider Business Mailing Address
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Address Line | 9116 GRAYFIELD
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City | REDFORD
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State | MI
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Zip | 48239-1132
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Country | US
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Telephone | 313-682-6370
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LENDEN FAVORS
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Credential | BA, MML
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Telephone | 313-682-6370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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