Healthcare Provider Details

I. General information

NPI: 1780106021
Provider Name (Legal Business Name): WHITES SENIOR ASSISTANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5988 N M 88
CENTRAL LAKE MI
49622-9464
US

IV. Provider business mailing address

PO BOX 264
EASTPORT MI
49627-0264
US

V. Phone/Fax

Practice location:
  • Phone: 231-392-2364
  • Fax:
Mailing address:
  • Phone: 231-392-2364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY WHITE
Title or Position: OWNER
Credential:
Phone: 231-392-2364