Provider Demographics
NPI:1659854313
Name:KENYATA'S AFC LLC
Entity Type:Organization
Organization Name:KENYATA'S AFC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENYATA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON-CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-475-9947
Mailing Address - Street 1:19152 CHESHIRE ST
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2012
Mailing Address - Country:US
Mailing Address - Phone:313-475-9947
Mailing Address - Fax:313-733-6660
Practice Address - Street 1:8136 SIRRON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3314
Practice Address - Country:US
Practice Address - Phone:313-893-5022
Practice Address - Fax:313-733-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAS820279800OtherLARA