Provider Demographics
NPI:1558662742
Name:TENILLE DANIEL
Entity Type:Organization
Organization Name:TENILLE DANIEL
Other - Org Name:HOME AWAY FROM HOME TRANSITIONAL HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TENILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-657-4777
Mailing Address - Street 1:PO BOX 34411
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234
Mailing Address - Country:US
Mailing Address - Phone:313-657-4777
Mailing Address - Fax:
Practice Address - Street 1:17210 RUNYON
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234
Practice Address - Country:US
Practice Address - Phone:313-657-4777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health