Provider Demographics
NPI:1194811950
Name:HALL'S ADULT FOSTER CARE HOME, INC.
Entity type:Organization
Organization Name:HALL'S ADULT FOSTER CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME PROVIDER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MACK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALL
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:313-247-8250
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-0267
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:313-491-4041
Practice Address - Street 1:27321 STANFORD ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-3176
Practice Address - Country:US
Practice Address - Phone:313-562-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities