Provider Demographics
NPI:1730330747
Name:THORN ADULT FOSTER CARE HOME
Entity type:Organization
Organization Name:THORN ADULT FOSTER CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:THORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-785-4324
Mailing Address - Street 1:4901 N SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48505-3511
Mailing Address - Country:US
Mailing Address - Phone:810-785-4324
Mailing Address - Fax:810-785-6294
Practice Address - Street 1:4901 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-3511
Practice Address - Country:US
Practice Address - Phone:810-785-4324
Practice Address - Fax:810-785-6294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM250008168320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0346445Medicaid