Provider Demographics
NPI:1255667366
Name:SALERY AFC
Entity Type:Organization
Organization Name:SALERY AFC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SALERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-702-7386
Mailing Address - Street 1:PO BOX 34384
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-0384
Mailing Address - Country:US
Mailing Address - Phone:313-870-9545
Mailing Address - Fax:313-870-9541
Practice Address - Street 1:7387 KIPLING ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2624
Practice Address - Country:US
Practice Address - Phone:131-870-9545
Practice Address - Fax:313-870-9541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS82094960320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities