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General NPI Number Information
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NPI Number | 1184202319
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Entity Type | Organization
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Legal Business Name | A PLACE CALLED HOME IN STEVENSVILLE LLC
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Dates
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Enumeration Date | 03/30/2021
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 4167 N ROOSEVELT RD
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City | STEVENSVILLE
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State | MI
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Zip | 49127-9119
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Country | US
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Telephone | 269-281-0357
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Fax | 269-281-0932
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Provider Business Mailing Address
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Address Line | 4167 N ROOSEVELT RD
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City | STEVENSVILLE
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State | MI
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Zip | 49127-9119
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Country | US
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Telephone | 269-281-0357
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Fax | 269-281-0932
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR/LICENSEE
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Name | MEAGAN NICOLE FRYE
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Credential |
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Telephone | 269-876-6523
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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 |
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License Number State |
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