Provider Demographics
NPI:1629833165
Name:CISSERIAC ASSISTED LIVING CARE LLC
Entity Type:Organization
Organization Name:CISSERIAC ASSISTED LIVING CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRONDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-782-3470
Mailing Address - Street 1:23332 FARMINGTON RD # 216
Mailing Address - Street 2:
Mailing Address - City:FARMINGTN HLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-9991
Mailing Address - Country:US
Mailing Address - Phone:313-782-3470
Mailing Address - Fax:
Practice Address - Street 1:28931 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1403
Practice Address - Country:US
Practice Address - Phone:313-782-3470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency