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General NPI Number Information
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NPI Number | 1043568207
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Entity Type | Organization
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Legal Business Name | LULLABY BABY
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Dates
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Enumeration Date | 08/20/2012
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Last Update Date | 08/20/2012
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Provider Practice Location Address
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Address Line | 16484 RADISON DR
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City | MACOMB
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State | MI
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Zip | 48044-4078
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Country | US
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Telephone | 586-604-0582
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Fax |
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Provider Business Mailing Address
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Address Line | 16484 RADISON DR
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City | MACOMB
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State | MI
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Zip | 48044-4078
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Country | US
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Telephone | 586-604-0582
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. NANCY EVANS
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Credential | MA.,LBSW
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Telephone | 586-604-0582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 597122
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License Number State | MI
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