=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225854144
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BYERLY ENTERPRISES II, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2024
-----------------------------------------------------
Last Update Date | 11/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6490 EASTLAWN AVE
-----------------------------------------------------
City | CLARKSTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48346-2422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-691-6400
-----------------------------------------------------
Fax | 248-574-5999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4759 OWASCO CT
-----------------------------------------------------
City | CLARKSTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48348-2273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-691-6400
-----------------------------------------------------
Fax | 248-574-5999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. CARL WESLEY BYERLY
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 819-691-6400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------