Healthcare Provider Details

I. General information

NPI: 1700973112
Provider Name (Legal Business Name): FRIENDS WHO CARE-JACKSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S WEST AVE
JACKSON MI
49201-2085
US

IV. Provider business mailing address

115 S WEST AVE
JACKSON MI
49201-2085
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-5710
  • Fax: 517-787-9855
Mailing address:
  • Phone: 517-787-5710
  • Fax: 517-787-9855

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: MS. GAYLE BUSSELLE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 248-968-5540