Provider Demographics
NPI:1891833414
Name:MICHIGAN AVENUE RESIDENTIAL CARE INC.
Entity type:Organization
Organization Name:MICHIGAN AVENUE RESIDENTIAL CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-367-8172
Mailing Address - Street 1:2820 WOODVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-1727
Mailing Address - Country:US
Mailing Address - Phone:517-367-8172
Mailing Address - Fax:517-853-0791
Practice Address - Street 1:1204 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1724
Practice Address - Country:US
Practice Address - Phone:517-367-8172
Practice Address - Fax:517-853-0791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities