Organization
FOUNTAIN OF LOVE ASSISTED LIVING SEVICES INC
Active
Other names
4-Wings Transportation
Organization subpart
No
Provider details
NPI number
Authorized official
SHANELL CLARK (PRESIDENT)
(248) 796-8004
Entity
Organization
Contact information
Practice address
21820 BEVERLY ST, OAK PARK, MI 48237-2503
(248) 796-7112
(248) 808-6052
Mailing address
21820 BEVERLY ST, OAK PARK, MI 48237-2503
(248) 796-7112
(248) 808-6052
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
06/27/2014
Last updated
04/21/2016
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