Provider Demographics
NPI:1396542940
Name:A SECOND HOME AFC, LLC
Entity type:Organization
Organization Name:A SECOND HOME AFC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-681-0776
Mailing Address - Street 1:18501 EMPIRE AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2609
Mailing Address - Country:US
Mailing Address - Phone:313-681-0776
Mailing Address - Fax:
Practice Address - Street 1:18501 EMPIRE AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2609
Practice Address - Country:US
Practice Address - Phone:313-681-0776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness