Provider Demographics
NPI:1245722032
Name:WATKINS AFC FAMILY HOME L.L.C.
Entity type:Organization
Organization Name:WATKINS AFC FAMILY HOME L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CORLISS
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-773-1682
Mailing Address - Street 1:49783 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-6821
Mailing Address - Country:US
Mailing Address - Phone:248-773-1682
Mailing Address - Fax:248-308-3283
Practice Address - Street 1:49783 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-6821
Practice Address - Country:US
Practice Address - Phone:248-773-1682
Practice Address - Fax:248-308-3283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)