Individual
MS. BEVERLY A KOONCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16520 WHITCOMB ST, DETROIT, MI 48235-3859
(313) 835-6557
Mailing address
16520 WHITCOMB ST, DETROIT, MI 48235-3859
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
230011513890806
MI
311ZA0620X
Adult Care Home Facility
Primary
3477-6190
MI
Other
Enumeration date
11/07/2008
Last updated
09/01/2011
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