Healthcare Provider Details

I. General information

NPI: 1013771351
Provider Name (Legal Business Name): COLLINS ADULT DAY CARE 24HR. OUT OF HOME RESPITE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 02/07/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 GREENWOOD AVE
JACKSON MI
49203
US

IV. Provider business mailing address

1201 GREENWOOD AVE
JACKSON MI
49203
US

V. Phone/Fax

Practice location:
  • Phone: 517-539-5169
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MECHELLE RENEE PALMER
Title or Position: OWNER/DIRECTOR
Credential: HIGH SCHOOL DIMPLOMA
Phone: 517-539-5169