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General NPI Number Information
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NPI Number | 1942720412
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Entity Type | Organization
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Legal Business Name | COUNTRY COMFORT SPECTRUM OF LIGHT
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1754 MERTZ RD
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City | CARO
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State | MI
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Zip | 48723-9533
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Country | US
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Telephone | 989-286-3088
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Fax |
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Provider Business Mailing Address
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Address Line | 1754 MERTZ RD
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City | CARO
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State | MI
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Zip | 48723-9533
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Country | US
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Telephone | 989-286-3088
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CRYSTAL BADER
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Credential |
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Telephone | 734-516-9824
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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 | AS790385117
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License Number State | MI
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