Organization
KAREN FREDERICK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JAZMINE M FORD (OWNER)
(313) 469-5946
Entity
Organization
Contact information
Practice address
5781 BEACONSFIELD ST, DETROIT, MI 48224-3157
(313) 469-5946
Mailing address
5796 BEACONSFIELD ST, DETROIT, MI 48224-3158
(313) 469-5946
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
AS820367993
MI
320800000X
Mental Illness Community Based Residential Treatment Facility
AS820367993
MI
Other
Enumeration date
05/11/2015
Last updated
05/11/2015
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