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General NPI Number Information
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NPI Number | 1811771488
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Entity Type | Organization
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Legal Business Name | POWELL HOUSE AFC
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Dates
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Enumeration Date | 08/23/2023
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 3531 NILES RD
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-8744
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Country | US
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Telephone | 269-281-0034
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Fax | 269-983-0303
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Provider Business Mailing Address
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Address Line | 3838 NILES RD
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-8612
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Country | US
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Telephone | 126-998-3030
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LORI COSTANZA
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Credential | RN
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Telephone | 269-983-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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