Provider Demographics
NPI: | 1295384154 |
---|---|
Name: | FOREVER FRIENDS ADULT DAY CENTER |
Entity Type: | Organization |
Organization Name: | FOREVER FRIENDS ADULT DAY CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT/OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CONNIE |
Authorized Official - Middle Name: | LOUISE |
Authorized Official - Last Name: | HUBBARD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 313-693-5486 |
Mailing Address - Street 1: | 8620 KINMORE ST |
Mailing Address - Street 2: | |
Mailing Address - City: | DEARBORN HEIGHTS |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48127-1269 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 313-693-5486 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 28050 FORD RD |
Practice Address - Street 2: | |
Practice Address - City: | GARDEN CITY |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48135-2967 |
Practice Address - Country: | US |
Practice Address - Phone: | 734-753-5444 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-09-04 |
Last Update Date: | 2019-09-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MI | 0189711 | Medicaid |