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General NPI Number Information
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NPI Number | 1982107108
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Entity Type | Organization
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Legal Business Name | DAISYS DAZZLING ADULT DAY CENTER LLC
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Dates
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Enumeration Date | 03/14/2018
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Last Update Date | 05/04/2018
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Provider Practice Location Address
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Address Line | 20400 PLYMOUTH RD
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City | DETROIT
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State | MI
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Zip | 48228-1222
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Country | US
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Telephone | 313-296-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 19335 MARLOWE ST
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City | DETROIT
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State | MI
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Zip | 48235-1948
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Country | US
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Telephone | 313-575-1644
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAISY ALDRIDGE
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Credential | LLP
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Telephone | 313-575-1644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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