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General NPI Number Information
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NPI Number | 1538052014
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Entity Type | Organization
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Legal Business Name | RESILIENCE NORTH LLC
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 7050 9 MILE RD
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City | MECOSTA
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State | MI
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Zip | 49332-9722
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Country | US
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Telephone | 231-679-6105
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Fax |
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Provider Business Mailing Address
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Address Line | 6713 SUNSET LN
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City | CANADIAN LAKES
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State | MI
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Zip | 49346-8832
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Country | US
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Telephone | 231-679-6105
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL BAUSANO
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Credential | LMSW
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Telephone | 231-679-6105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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