Healthcare Provider Details

I. General information

NPI: 1306359005
Provider Name (Legal Business Name): HOMELIFE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9445 N 24TH ST
RICHLAND MI
49083-9515
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 269-488-0024
  • Fax: 269-488-0025
Mailing address:
  • Phone: 269-660-0854
  • Fax: 269-660-0964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberAS390281218
License Number StateMI

VIII. Authorized Official

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