=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396185062
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUNDLES OF JOY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2013
-----------------------------------------------------
Last Update Date | 06/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6879 LAKEVIEW BLVD APT 4205
-----------------------------------------------------
City | WESTLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48185-5805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-304-4334
-----------------------------------------------------
Fax | 248-415-6268
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6879 LAKEVIEW BLVD APT 4205
-----------------------------------------------------
City | WESTLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48185-5805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-304-4334
-----------------------------------------------------
Fax | 248-415-6268
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. KEYONNA ELAINE WELLS
-----------------------------------------------------
Credential | LLBSW
-----------------------------------------------------
Telephone | 313-304-4334
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------