Healthcare Provider Details

I. General information

NPI: 1902602444
Provider Name (Legal Business Name): THE VILLAGE COMFORT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 POPLAR LN APT 102
EAST LANSING MI
48823
US

IV. Provider business mailing address

1104 POPLAR LN APT 102
EAST LANSING MI
48823-2543
US

V. Phone/Fax

Practice location:
  • Phone: 517-990-0203
  • Fax:
Mailing address:
  • Phone: 313-268-3751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: RUTH MARIAM ABDULLAH
Title or Position: OWNER
Credential:
Phone: 313-268-3751