Healthcare Provider Details

I. General information

NPI: 1346622867
Provider Name (Legal Business Name): RESTART VETERANS FOSTER HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2015
Last Update Date: 06/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 LAKEVIEW DR SUITE # 135
YPSILANTI MI
48198-6754
US

IV. Provider business mailing address

2105 LAKEVIEW DR SUITE # 135
YPSILANTI MI
48198-6754
US

V. Phone/Fax

Practice location:
  • Phone: 480-276-7144
  • Fax:
Mailing address:
  • Phone: 480-276-1466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. EMELYN BESEM
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 480-276-1466