Provider Demographics
NPI:1043759111
Name:FARRAGUT HOME CARE LLC
Entity Type:Organization
Organization Name:FARRAGUT HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AFC PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TESIE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUITON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-291-4326
Mailing Address - Street 1:634 S WHITMAN CT SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-7711
Mailing Address - Country:US
Mailing Address - Phone:616-291-4326
Mailing Address - Fax:616-956-0441
Practice Address - Street 1:1839 FARRAGUT ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-1734
Practice Address - Country:US
Practice Address - Phone:616-291-4326
Practice Address - Fax:616-956-0441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM410245599311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home