Organization
SUPREME INDEPENDENCE ROOM AND BOARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES BLAKE (OWNER)
(810) 660-1892
Entity
Organization
Contact information
Practice address
12844 BROADSTREET AVE, DETROIT, MI 48238-3250
(313) 459-9538
Mailing address
36306 DOMINION CIR, STERLING HEIGHTS, MI 48310-7458
(810) 660-1892
Taxonomy
Speciality
Code
Description
License number
State
177F00000X
Lodging Provider
Primary
—
—
Other
Enumeration date
10/26/2021
Last updated
10/26/2021
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