Provider Demographics
NPI:1750851226
Name:FONAG, INC.
Entity type:Organization
Organization Name:FONAG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MFON
Authorized Official - Middle Name:
Authorized Official - Last Name:UKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-664-7193
Mailing Address - Street 1:40946 CROSSBOW CIR APT 105
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-3156
Mailing Address - Country:US
Mailing Address - Phone:734-664-7194
Mailing Address - Fax:734-331-9589
Practice Address - Street 1:44257 ECORSE RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-1173
Practice Address - Country:US
Practice Address - Phone:734-664-7194
Practice Address - Fax:734-331-9589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health