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General NPI Number Information
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NPI Number | 1679237473
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Entity Type | Organization
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Legal Business Name | CLARKSTON COMFORT CARE
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Dates
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Enumeration Date | 10/27/2021
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 5850 WHITE LAKE RD
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City | CLARKSTON
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State | MI
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Zip | 48346-2658
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Country | US
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Telephone | 248-320-3196
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Fax |
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Provider Business Mailing Address
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Address Line | 5850 WHITE LAKE RD
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City | CLARKSTON
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State | MI
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Zip | 48346-2658
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Country | US
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Telephone | 248-320-3196
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DOUGLAS BOEHM
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Credential |
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Telephone | 248-930-7875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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