Provider Demographics
NPI:1720451180
Name:INETGRATED ADULT HOME CARE AGENCY,LLC
Entity type:Organization
Organization Name:INETGRATED ADULT HOME CARE AGENCY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TANYI
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:AGBOR-BAIYEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-635-7044
Mailing Address - Street 1:11425 SAINT ALOYSIUS ST
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-1187
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11425 SAINT ALOYSIUS ST
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-1187
Practice Address - Country:US
Practice Address - Phone:734-635-7044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820340264311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home