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General NPI Number Information
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NPI Number | 1124665054
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Entity Type | Organization
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Legal Business Name | BASELINE, L.L.C.
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Dates
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Enumeration Date | 12/10/2019
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 122 W CROSSTOWN PKWY
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City | KALAMAZOO
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State | MI
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Zip | 49001-2742
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Country | US
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Telephone | 269-501-5670
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 160
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City | GOBLES
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State | MI
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Zip | 49055-0160
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Country | US
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Telephone | 269-501-5670
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID FERRY
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Credential | L.L.P.
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Telephone | 269-501-5670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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