Provider Demographics
NPI:1760848915
Name:HEART'S OF UNITY FAMILY CARE HOME
Entity Type:Organization
Organization Name:HEART'S OF UNITY FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:AMELIA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-454-9293
Mailing Address - Street 1:12103 GLENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-4100
Mailing Address - Country:US
Mailing Address - Phone:313-454-9293
Mailing Address - Fax:
Practice Address - Street 1:12103 GLENFIELD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-4100
Practice Address - Country:US
Practice Address - Phone:313-454-9293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF820375443253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI25E00000XOtherHOME HEALTH