MEDICARE: VILLAGE KEEPERS, LLC

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

General Provider Information

NPI Number	:	1750988515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE KEEPERS, LLC

Provider Business Mailing Address
First Line	:	18283 FREELAND ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-2537
Country	:	US
Telephone Number	:	313-422-3369
Fax Number	:

Provider Business Practice Location Address
First Line	:	18283 FREELAND ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-2537
Country	:	US
Telephone Number	:	313-422-3369
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	MRS. STACEY Y HAYES
Credential	:	LLBSW
Telephone Number	:	313-422-3369

Provider Enumeration Date	:	10/05/2020
Last Update Date	:	10/05/2020

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