Provider Demographics
NPI:1093000416
Name:AMAYA GROUP HOME
Entity Type:Organization
Organization Name:AMAYA GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LISCENSEE
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-215-1551
Mailing Address - Street 1:59755 HAVENRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48048-1916
Mailing Address - Country:US
Mailing Address - Phone:313-215-1551
Mailing Address - Fax:
Practice Address - Street 1:59755 HAVENRIDGE RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MI
Practice Address - Zip Code:48048-1916
Practice Address - Country:US
Practice Address - Phone:313-215-1551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF500305306253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency