Provider Demographics
NPI:1477636512
Name:BRUNETTE'S ADULT RESIDENTIAL CARE FACILITY, INC.
Entity Type:Organization
Organization Name:BRUNETTE'S ADULT RESIDENTIAL CARE FACILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-378-0322
Mailing Address - Street 1:9051 WHITEHORN ST
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-4152
Mailing Address - Country:US
Mailing Address - Phone:734-721-0102
Mailing Address - Fax:734-721-2901
Practice Address - Street 1:9051 WHITEHORN ST
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-4152
Practice Address - Country:US
Practice Address - Phone:734-721-0102
Practice Address - Fax:734-721-2901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities