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General NPI Number Information
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NPI Number | 1922558329
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Entity Type | Organization
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Legal Business Name | REFLECTIONS OF THURSTON WOODS
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 1946 S. THURSTON WOODS DRIVE
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City | STURGIS
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State | MI
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Zip | 49091
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Country | US
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Telephone | 269-319-6505
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Fax |
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Provider Business Mailing Address
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Address Line | 307 N. FRANKS AVE.
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City | STURGIS
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State | MI
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Zip | 49091
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Country | US
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Telephone | 269-651-7841
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. THEO OMO
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Credential |
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Telephone | 269-651-7841
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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 | AM750378700
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License Number State | MI
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