Healthcare Provider Details

I. General information

NPI: 1891471041
Provider Name (Legal Business Name): STEPHENS HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 FENTON ST
BATTLE CREEK MI
49037-2615
US

IV. Provider business mailing address

146 FENTON ST
BATTLE CREEK MI
49037-2615
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. TEZIAH D MANUMBU
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 269-300-5799