Healthcare Provider Details

I. General information

NPI: 1770097461
Provider Name (Legal Business Name): HOMELIFE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6595 RAVINE ROAD
KALAMAZOO MI
49009-9075
US

IV. Provider business mailing address

5420A BECKLEY ROAD, PMB 360
BATTLE CREEK MI
49015-4181
US

V. Phone/Fax

Practice location:
  • Phone: 269-488-3968
  • Fax: 269-488-3969
Mailing address:
  • Phone: 269-660-0854
  • Fax: 269-660-0964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberAS390287535
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. BARRY J. BRUNS
Title or Position: PRESIDENT
Credential:
Phone: 269-660-0854