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General NPI Number Information
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NPI Number | 1215033600
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Entity Type | Organization
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Legal Business Name | THE LIVING ROOM
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 MACDONALD DR
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City | PETOSKEY
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State | MI
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Zip | 49770-4406
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Country | US
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Telephone | 231-487-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 416 CONNABLE AVE
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City | PETOSKEY
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State | MI
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Zip | 49770-2212
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Country | US
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Telephone | 231-487-4000
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Fax |
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Authorized Official
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Title or Position | RVE MGMT
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Name | JERRY BUSH
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Credential |
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Telephone | 231-487-4242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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