Provider Demographics
NPI:1528569209
Name:MICHIGAN ADULT EMPOWERMENT CENTER, LLC
Entity Type:Organization
Organization Name:MICHIGAN ADULT EMPOWERMENT CENTER, LLC
Other - Org Name:MICHIGAN ADULT EMPOWERMENT DAYCARE CENTER, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TITO
Authorized Official - Middle Name:TIMMONS
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-300-7177
Mailing Address - Street 1:25681 CODE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-5813
Mailing Address - Country:US
Mailing Address - Phone:313-300-7177
Mailing Address - Fax:
Practice Address - Street 1:19309 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2004
Practice Address - Country:US
Practice Address - Phone:313-300-7177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care