=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861977597
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REDEEMED AMERICAN HOMES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2018
-----------------------------------------------------
Last Update Date | 09/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28545 FORD RD
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48135-2843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-266-6115
-----------------------------------------------------
Fax | 734-922-2834
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 871665
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48187-4365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-266-6115
-----------------------------------------------------
Fax | 734-922-2834
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/CEO
-----------------------------------------------------
Name | MS. PRINCESS KENNEDY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-522-9587
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253J00000X
-----------------------------------------------------
Taxonomy Name | Foster Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------