Provider Demographics
NPI:1619059573
Name:CARSON ADULT FOSTER CARE, INC.
Entity Type:Organization
Organization Name:CARSON ADULT FOSTER CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:313-863-7050
Mailing Address - Street 1:19384 JAMES COUZENS FWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1961
Mailing Address - Country:US
Mailing Address - Phone:313-863-7050
Mailing Address - Fax:313-863-1524
Practice Address - Street 1:19384 JAMES COUZENS FWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1961
Practice Address - Country:US
Practice Address - Phone:313-863-7050
Practice Address - Fax:313-863-1524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM8220009843171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty