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General NPI Number Information
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NPI Number | 1922513902
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Entity Type | Organization
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Legal Business Name | JOSHUA STREET RESIDENTIAL CARE & REHABILITATIVE SERVICES
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 12/12/2017
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Provider Practice Location Address
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Address Line | 809 CENTER ST STE 9A
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City | LANSING
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State | MI
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Zip | 48906-5258
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Country | US
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Telephone | 517-882-3544
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Fax | 517-882-3525
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Provider Business Mailing Address
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Address Line | PO BOX 1362
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City | EAST LANSING
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State | MI
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Zip | 48826-1362
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Country | US
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Telephone | 517-882-3544
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Fax | 517-882-3525
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | KATREVA N BISBEE
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Credential |
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Telephone | 517-882-3544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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