Organization
DETROIT FAMILY HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEAN FELIX NYAMBIO CRNA (CEO)
(301) 332-3009
Entity
Organization
Contact information
Practice address
17180 INDIANA ST, DETROIT, MI 48221-2445
(313) 270-7751
(313) 270-7291
Mailing address
17180 INDIANA ST, DETROIT, MI 48221-2445
(313) 270-7751
(313) 270-7291
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
AS820338244
MI
311ZA0620X
Adult Care Home Facility
AS820338244
MI
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
AS820338244
MI
320700000X
Physical Disabilities Residential Treatment Facility
AS820338244
MI
320800000X
Mental Illness Community Based Residential Treatment Facility
AS820338244
MI
385H00000X
Respite Care
AS820338244
MI
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
AS820338244
MI
Other
Enumeration date
08/13/2013
Last updated
12/22/2017
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