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General NPI Number Information
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NPI Number | 1366178105
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Entity Type | Organization
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Legal Business Name | BLOOMINGDALE SENIOR SERVICES LLC
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 01546 COUNTY ROAD 665
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City | BLOOMINGDALE
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State | MI
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Zip | 49026-8756
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Country | US
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Telephone | 269-512-6163
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Fax |
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Provider Business Mailing Address
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Address Line | 01546 COUNTY ROAD 665
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City | BLOOMINGDALE
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State | MI
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Zip | 49026-8756
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Country | US
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Telephone | 269-512-6163
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. TERRY L MCCULLOUGH
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Credential | MSW
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Telephone | 269-512-6163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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