Provider Demographics
NPI:1013003367
Name:FRIENDS WHO CARE-ADRIAN, LLC
Entity Type:Organization
Organization Name:FRIENDS WHO CARE-ADRIAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:BUSSELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-542-2424
Mailing Address - Street 1:808 W CHICAGO BLVD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-1666
Mailing Address - Country:US
Mailing Address - Phone:517-423-0004
Mailing Address - Fax:517-423-0010
Practice Address - Street 1:808 W CHICAGO BLVD
Practice Address - Street 2:SUITE 13
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-1666
Practice Address - Country:US
Practice Address - Phone:517-423-0004
Practice Address - Fax:517-423-0010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRIENDS WHO CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-05
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI15 4360747Medicaid