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General NPI Number Information
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NPI Number | 1275886665
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Entity Type | Organization
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Legal Business Name | CLOSEST PLACE TO HOME LLC
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 19810 WESTMORELAND RD
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City | DETROIT
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State | MI
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Zip | 48219-5106
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Country | US
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Telephone | 313-350-8698
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Fax | 248-427-1165
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Provider Business Mailing Address
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Address Line | 35630 GRAND RIVER AVE SUITE 210A
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City | FARMINGTON HILLS
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State | MI
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Zip | 48335-3133
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Country | US
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Telephone | 313-350-8698
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Fax | 248-427-1165
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAVAUGHN S JONES
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Credential |
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Telephone | 313-350-8698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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