Provider Demographics
NPI:1659069359
Name:MARY'S RESIDENTIAL CARE FOR SENIORS, INC
Entity Type:Organization
Organization Name:MARY'S RESIDENTIAL CARE FOR SENIORS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GYAMFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-778-8801
Mailing Address - Street 1:35225 SILVANO ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2686
Mailing Address - Country:US
Mailing Address - Phone:248-778-8801
Mailing Address - Fax:586-790-4376
Practice Address - Street 1:35225 SILVANO ST
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-2686
Practice Address - Country:US
Practice Address - Phone:586-790-0640
Practice Address - Fax:586-790-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness