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General NPI Number Information
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NPI Number | 1932491487
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Entity Type | Organization
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Legal Business Name | CARLA'S COMP-ANIONSHIP & CARE LLC
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 30739 TAMARACK ST. #40101
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City | WIXOM
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State | MI
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Zip | 48393
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Country | US
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Telephone | 248-495-9066
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Fax |
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Provider Business Mailing Address
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Address Line | 30739 TAMARACK ST APT 40101
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City | WIXOM
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State | MI
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Zip | 48393-2733
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. CARLA T. JEFFERSON
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Credential | BUSINESS OWNER
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Telephone | 248-495-9066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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