Organization
TIMELESS TREASURE VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOUIS CORNELUIS BROOKS I (CHIEF EXECUTIVE)
(313) 768-4048
Entity
Organization
Contact information
Practice address
23636 MICHIGAN AVE # 488, DEARBORN, MI 48124-1910
(313) 768-4084
Mailing address
23636 MICHIGAN AVE # 488, DEARBORN, MI 48124-1910
(313) 523-7807
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
04/08/2015
Last updated
04/08/2015
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