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General NPI Number Information
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NPI Number | 1902555006
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Entity Type | Organization
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Legal Business Name | SERVANT HEART KEEPERS ADULT LIVING
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 15494 HARTWELL ST
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City | DETROIT
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State | MI
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Zip | 48227-3329
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Country | US
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Telephone | 989-533-9718
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Fax |
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Provider Business Mailing Address
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Address Line | 15494 HARTWELL ST
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City | DETROIT
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State | MI
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Zip | 48227-3329
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Country | US
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Telephone | 989-533-9718
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Fax |
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Authorized Official
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Title or Position | HEALTHCARE MANAGER
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Name | PAULA L HESTER
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Credential |
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Telephone | 989-533-9718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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Taxonomy #6
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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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Taxonomy #7
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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 |
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Taxonomy #8
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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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