Provider Demographics
NPI:1124735311
Name:VILLAGE OF VIRTUE LLC
Entity type:Organization
Organization Name:VILLAGE OF VIRTUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF VILLAGE OF VIRTUE LLC
Authorized Official - Prefix:
Authorized Official - First Name:MARKEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-687-3729
Mailing Address - Street 1:2979 HAZELWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-2132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2979 HAZELWOOD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2132
Practice Address - Country:US
Practice Address - Phone:313-656-4023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No253J00000XAgenciesFoster Care Agency