Individual
LORA JEAN DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARDMS, AFC
Contact information
Practice address
3307 HOUSTON ST, DEARBORN, MI 48124-4159
(313) 278-2805
(313) 278-5243
Mailing address
PO BOX 2977, SOUTHFIELD, MI 48037-2977
(313) 590-9139
(313) 278-5243
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
MI
320700000X
Physical Disabilities Residential Treatment Facility
—
MI
320800000X
Mental Illness Community Based Residential Treatment Facility
—
MI
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
MI
Other
Enumeration date
01/05/2020
Last updated
02/04/2022
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