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General NPI Number Information
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NPI Number | 1609031251
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Entity Type | Organization
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Legal Business Name | CARE & COMFORT STATION
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Dates
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Enumeration Date | 07/23/2008
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 22777 HARPER AVE SUITE 103 A
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1868
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Country | US
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Telephone | 586-777-0593
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Fax | 586-779-3282
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Provider Business Mailing Address
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Address Line | 22777 HARPER AVE SUITE 103 A
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1868
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Country | US
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Telephone | 586-777-0593
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Fax | 586-779-3282
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Authorized Official
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Title or Position | ADMINISTRATOR/WOUND SPECIALIST
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Name | MRS. LAYNETTE GOUDY
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Credential | NURSE PRACTITIONER
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Telephone | 586-777-0593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 4704114991
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License Number State | MI
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