Healthcare Provider Details

I. General information

NPI: 1104053123
Provider Name (Legal Business Name): CARE COMMUITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 GENERAL AVE
SPRINGFIELD MI
49037-7553
US

IV. Provider business mailing address

565 GENERAL AVE
SPRINGFIELD MI
49037-7553
US

V. Phone/Fax

Practice location:
  • Phone: 269-968-3365
  • Fax: 269-968-2446
Mailing address:
  • Phone: 269-968-3365
  • Fax: 269-968-2446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAH130254365
License Number StateMI

VIII. Authorized Official

Name: MR. JAMES BRIAN CAREY
Title or Position: PRESIDENT
Credential:
Phone: 269-968-3365