NPI 1972267870
Supreme Independence Room and Board
Practice location
- Address
- 12844 Broadstreet Ave, Detroit, MI 48238-3250
- Phone
- (313) 459-9538
- Mailing address
- 36306 Dominion Cir, Sterling Heights, MI 48310-7458
Authorised official
- Name
- James Blake
- Title
- Owner
- Phone
- (810) 660-1892
Registered specialties
Lodging Provider
Primary
Registry record
- NPI
- 1972267870
- Entity type
- Organization
- NPI issued
- 26 Oct 2021
- Record last updated
- 26 Oct 2021
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.