Organization
KENYATA'S AFC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KENYATA HAMILTON-CARTER (ADMINISTRATOR)
(313) 475-9947
Entity
Organization
Contact information
Practice address
8136 SIRRON ST, DETROIT, MI 48234-3314
(313) 893-5022
(313) 733-6660
Mailing address
19152 CHESHIRE ST, GROSSE POINTE, MI 48236-2012
(313) 475-9947
(313) 733-6660
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AS820279800
LARA
MI
Enumeration date
09/10/2018
Last updated
09/10/2018
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