Provider Demographics
NPI:1902448731
Name:SIMEON'S REST ADULT DAY PROGRAM
Entity Type:Organization
Organization Name:SIMEON'S REST ADULT DAY PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLNESS
Authorized Official - Suffix:
Authorized Official - Credentials:B/A OF SCIENCE
Authorized Official - Phone:734-560-5872
Mailing Address - Street 1:46500 N TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3066
Mailing Address - Country:US
Mailing Address - Phone:734-560-5872
Mailing Address - Fax:
Practice Address - Street 1:46500 N TERRITORIAL RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-3066
Practice Address - Country:US
Practice Address - Phone:734-207-9673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care