Healthcare Provider Details

I. General information

NPI: 1639755705
Provider Name (Legal Business Name): THE DIGNIFIED AGING PROJECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 BEMENT ST
LANSING MI
48912-1703
US

IV. Provider business mailing address

1125 BEMENT ST
LANSING MI
48912-1703
US

V. Phone/Fax

Practice location:
  • Phone: 517-488-3311
  • Fax:
Mailing address:
  • Phone: 517-488-3311
  • Fax: 517-659-6119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. YOLANDA R POPE
Title or Position: OWNER
Credential: LPN
Phone: 517-488-3311