Provider Demographics
NPI:1346435302
Name:TENISHA'S ADULT FOSTER CARE HOME
Entity Type:Organization
Organization Name:TENISHA'S ADULT FOSTER CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TENISHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1248-390-8128
Mailing Address - Street 1:73 FAIRGROVE ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2309
Mailing Address - Country:US
Mailing Address - Phone:248-390-8128
Mailing Address - Fax:
Practice Address - Street 1:73 FAIRGROVE ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2309
Practice Address - Country:US
Practice Address - Phone:248-390-8128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home