Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Organization
FOUNTAIN OF LOVE ASSISTED LIVING INC
Active
Organization
FOUNTAIN OF LOVE ASSISTED LIVING INC
Active
Other names
The Loving Head Quarter
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHANELL CLARK (OFFICER)
(248) 796-7291
Entity
Organization
Contact information
Practice address
21820 BEVERLY ST, OAK PARK, MI 48237-2503
(248) 796-7291
Mailing address
21820 BEVERLY ST, OAK PARK, MI 48237-2503
(248) 796-7291
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
310400000X
Assisted Living Facility
AF630309030
MI
311ZA0620X
Adult Care Home Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
08/30/2010
Last updated
11/15/2018
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up