Provider Demographics
NPI:1295579290
Name:TERRY ADULT FOSTER CARE INC.
Entity type:Organization
Organization Name:TERRY ADULT FOSTER CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:VADIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-491-6023
Mailing Address - Street 1:12747 INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-3078
Mailing Address - Country:US
Mailing Address - Phone:313-491-6023
Mailing Address - Fax:313-931-3474
Practice Address - Street 1:1754 VAN DYKE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-2634
Practice Address - Country:US
Practice Address - Phone:313-921-3957
Practice Address - Fax:313-931-3474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness