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General NPI Number Information
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NPI Number | 1124267554
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Entity Type | Organization
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Legal Business Name | COMFORT LIVING HOME L.L.C
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Dates
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Enumeration Date | 02/09/2009
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Last Update Date | 02/09/2009
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Provider Practice Location Address
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Address Line | 2111 N DRAKE RD
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City | KALAMAZOO
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State | MI
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Zip | 49006-1346
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Country | US
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Telephone | 269-343-3566
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Fax |
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Provider Business Mailing Address
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Address Line | 2111 N DRAKE RD
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City | KALAMAZOO
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State | MI
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Zip | 49006-1346
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS CAVEL YOUNG
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Credential |
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Telephone | 269-760-1182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AS390292207
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License Number State | MI
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