Healthcare Provider Details

I. General information

NPI: 1235964867
Provider Name (Legal Business Name): BAILEYS HOME FOR THE AGED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24755 HILL AVE
WARREN MI
48091-4459
US

IV. Provider business mailing address

24755 HILL AVE
WARREN MI
48091-4459
US

V. Phone/Fax

Practice location:
  • Phone: 586-625-7403
  • Fax:
Mailing address:
  • Phone: 586-625-7403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PATRICE MITCHELL
Title or Position: OWNER
Credential:
Phone: 586-625-7403