MEDICARE: STAA-RESIDENTIAL SERVICES NETWORK LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1528950466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAA-RESIDENTIAL SERVICES NETWORK LLC

Provider Business Mailing Address
First Line	:	503 COLUMBIA AVE E
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-5412
Country	:	US
Telephone Number	:	269-300-5799
Fax Number	:	269-300-5799

Provider Business Practice Location Address
First Line	:	503 COLUMBIA AVE E
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-5412
Country	:	US
Telephone Number	:	269-300-5799
Fax Number	:	269-300-5799

Authorized Official
Title or Position	:	ADMIN
Name	:	TEZIAH D MANUMBU
Credential	:
Telephone Number	:	269-300-5799

Provider Enumeration Date	:	07/16/2025
Last Update Date	:	07/16/2025

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