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General NPI Number Information
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NPI Number | 1093565590
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Entity Type | Organization
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Legal Business Name | RESIDECARE LLC
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Dates
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Enumeration Date | 03/26/2024
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 1161 NASH AVE
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City | YPSILANTI
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State | MI
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Zip | 48198-6291
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Country | US
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Telephone | 734-460-2558
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Fax | 734-533-6066
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Provider Business Mailing Address
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Address Line | PO BOX 970235
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City | YPSILANTI
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State | MI
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Zip | 48197-0031
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Country | US
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Telephone |
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Fax | 269-666-6098
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Authorized Official
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Title or Position | CREDENTIALING
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Name | SUSAN CATHERMAN
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Credential |
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Telephone | 267-767-6851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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