Healthcare Provider Details

I. General information

NPI: 1528950466
Provider Name (Legal Business Name): STAA-RESIDENTIAL SERVICES NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 COLUMBIA AVE E
BATTLE CREEK MI
49014-5412
US

IV. Provider business mailing address

503 COLUMBIA AVE E
BATTLE CREEK MI
49014-5412
US

V. Phone/Fax

Practice location:
  • Phone: 269-300-5799
  • Fax: 269-300-5799
Mailing address:
  • Phone: 269-300-5799
  • Fax: 269-300-5799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TEZIAH D MANUMBU
Title or Position: ADMIN
Credential:
Phone: 269-300-5799