MEDICARE: AALIYAH ARCHIE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker		MI

General Provider Information

NPI Number	:	1366331258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AALIYAH ARCHIE

Provider Business Mailing Address
First Line	:	560 PALMERSTON ST
Second Line	:
City	:	RIVER ROUGE
State	:	MI
Zip	:	48218-1154
Country	:	US
Telephone Number	:	313-957-8893
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 PALMERSTON ST
Second Line	:
City	:	RIVER ROUGE
State	:	MI
Zip	:	48218-1154
Country	:	US
Telephone Number	:	313-957-8893
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2025
Last Update Date	:	07/02/2025

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Directions to “ AALIYAH ARCHIE ” Practice Location

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