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General NPI Number Information
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NPI Number | 1265719116
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Entity Type | Organization
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Legal Business Name | MORRELL'S FAMILY HOME
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Dates
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Enumeration Date | 11/07/2011
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Last Update Date | 11/07/2011
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Provider Practice Location Address
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Address Line | 1212 110TH AVE
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City | MARTIN
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State | MI
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Zip | 49070-9721
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Country | US
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Telephone | 269-692-2400
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Fax | 269-692-6020
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Provider Business Mailing Address
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Address Line | 1212 110TH AVE
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City | MARTIN
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State | MI
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Zip | 49070-9721
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Country | US
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Telephone | 269-692-2400
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Fax | 269-692-6020
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | MS. GLENDA MARIE PILLARS
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Credential |
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Telephone | 269-692-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | AF030293174
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License Number State | MI
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