Individual
ESTI POP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23600 MIDDLEBELT RD, FARMINGTON HILLS, MI 48336-2911
(248) 631-6105
Mailing address
23600 MIDDLEBELT RD, FARMINGTON HILLS, MI 48336-2911
(248) 631-6105
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
AF630388988
MI
Other
Enumeration date
11/13/2019
Last updated
11/13/2019
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