Provider Demographics
NPI:1306510193
Name:FAVORED GROUP HOME, INC.
Entity type:Organization
Organization Name:FAVORED GROUP HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ONAJITE
Authorized Official - Middle Name:QUEEN
Authorized Official - Last Name:TOWEH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-250-4514
Mailing Address - Street 1:18346 15 1/2 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-9433
Mailing Address - Country:US
Mailing Address - Phone:248-250-4514
Mailing Address - Fax:269-789-9426
Practice Address - Street 1:15836 BEECH DALY RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3806
Practice Address - Country:US
Practice Address - Phone:248-250-4514
Practice Address - Fax:269-789-9426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency