Organization
MY PLACE AFC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SAMANTHA M EVANS (PRESIDENT)
(313) 510-2879
Entity
Organization
Contact information
Practice address
21415 SHERMAN AVE, SOUTHFIELD, MI 48033-4388
(313) 510-2879
(248) 559-5692
Mailing address
15565 NORTHLAND DR E STE 901, SOUTHFIELD, MI 48075-5331
(248) 559-5683
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
04/13/2018
Last updated
04/13/2018
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