=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295657948
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MURIELS PLACE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2026
-----------------------------------------------------
Last Update Date | 07/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 FRUIT ST
-----------------------------------------------------
City | SOUTH HAVEN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49090-1723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-637-1428
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 FRUIT ST
-----------------------------------------------------
City | SOUTH HAVEN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49090-1723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-637-1428
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MONIQUE CROWLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 269-447-7934
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------