Provider Demographics
NPI:1023559853
Name:SUJI HOME LLC
Entity Type:Organization
Organization Name:SUJI HOME LLC
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:FRIDA
Authorized Official - Middle Name:REUBEN
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-207-5965
Mailing Address - Street 1:319 N SAGE ST
Mailing Address - Street 2:319 NORTH SAGE STREET
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-4040
Mailing Address - Country:US
Mailing Address - Phone:269-341-4337
Mailing Address - Fax:
Practice Address - Street 1:319 N SAGE ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-4040
Practice Address - Country:US
Practice Address - Phone:269-341-4337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS390383907172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty