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General NPI Number Information
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NPI Number | 1891833414
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Entity Type | Organization
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Legal Business Name | MICHIGAN AVENUE RESIDENTIAL CARE INC.
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Dates
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Enumeration Date | 02/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1204 W MICHIGAN AVE
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City | LANSING
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State | MI
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Zip | 48915-1724
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Country | US
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Telephone | 517-367-8172
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Fax | 517-853-0791
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Provider Business Mailing Address
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Address Line | 2820 WOODVIEW DR
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City | LANSING
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State | MI
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Zip | 48911-1727
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Country | US
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Telephone | 517-367-8172
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Fax | 517-853-0791
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. HOPE MERCEDES LOVELL
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Credential |
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Telephone | 517-367-8172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | MI
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