Provider Demographics
NPI:1821506072
Name:FREDERICKS FAMILY HOMES AFC INC
Entity Type:Organization
Organization Name:FREDERICKS FAMILY HOMES AFC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ALLES
Authorized Official - Suffix:
Authorized Official - Credentials:PROVIDER
Authorized Official - Phone:734-330-6400
Mailing Address - Street 1:14705 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2552
Mailing Address - Country:US
Mailing Address - Phone:734-287-8982
Mailing Address - Fax:
Practice Address - Street 1:14705 ALLEN RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2552
Practice Address - Country:US
Practice Address - Phone:734-287-8982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
1497951156OtherADULT FOSTER CARE