Healthcare Provider Details

I. General information

NPI: 1417401522
Provider Name (Legal Business Name): CELESTIAL HOMES ASSISTED LIVING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WHITTEMORE ST
PONTIAC MI
48342-3069
US

IV. Provider business mailing address

201 WHITTEMORE ST
PONTIAC MI
48342-3069
US

V. Phone/Fax

Practice location:
  • Phone: 248-421-6705
  • Fax:
Mailing address:
  • Phone: 248-421-6705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0146282
License Number StateMI

VIII. Authorized Official

Name: MARY RUSSELL
Title or Position: MANAGER
Credential:
Phone: 248-421-6705