Healthcare Provider Details

I. General information

NPI: 1922513902
Provider Name (Legal Business Name): JOSHUA STREET RESIDENTIAL CARE & REHABILITATIVE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 CENTER ST STE 9A
LANSING MI
48906-5258
US

IV. Provider business mailing address

PO BOX 1362
EAST LANSING MI
48826-1362
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3544
  • Fax: 517-882-3525
Mailing address:
  • Phone: 517-882-3544
  • Fax: 517-882-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KATREVA N BISBEE
Title or Position: BILLING SPECIALIST
Credential:
Phone: 517-882-3544