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General NPI Number Information
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NPI Number | 1790189777
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Entity Type | Organization
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Legal Business Name | COMMUNITY LINX
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 8291 ROLLING HILL LN
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City | GRAND LEDGE
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State | MI
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Zip | 48837-9251
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Country | US
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Telephone | 517-574-2987
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Fax | 517-622-8012
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Provider Business Mailing Address
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Address Line | 8291 ROLLING HILL LN
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City | GRAND LEDGE
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State | MI
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Zip | 48837-9251
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Country | US
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Telephone | 517-574-2987
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Fax | 517-622-8012
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. DUANA BENN
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Credential | BSW
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Telephone | 517-574-2987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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