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General NPI Number Information
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NPI Number | 1447120712
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Entity Type | Organization
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Legal Business Name | EMBRACED RESIDENTIAL LIVING LLC
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Dates
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Enumeration Date | 11/10/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 712 EGLESTON AVE
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City | KALAMAZOO
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State | MI
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Zip | 49001-3867
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Country | US
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Telephone | 269-202-8933
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Fax | 269-234-2223
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Provider Business Mailing Address
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Address Line | 712 EGLESTON AVE
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City | KALAMAZOO
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State | MI
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Zip | 49001-3867
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Country | US
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Telephone | 269-202-8933
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Fax | 269-234-2223
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE DEAN
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Credential |
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Telephone | 269-202-8933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment 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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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