Healthcare Provider Details

I. General information

NPI: 1275886665
Provider Name (Legal Business Name): CLOSEST PLACE TO HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19810 WESTMORELAND RD
DETROIT MI
48219-5106
US

IV. Provider business mailing address

35630 GRAND RIVER AVE SUITE 210A
FARMINGTON HILLS MI
48335-3133
US

V. Phone/Fax

Practice location:
  • Phone: 313-350-8698
  • Fax: 248-427-1165
Mailing address:
  • Phone: 313-350-8698
  • Fax: 248-427-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: MR. JAVAUGHN S JONES
Title or Position: OWNER
Credential:
Phone: 313-350-8698