Provider Demographics
NPI:1184202319
Name:A PLACE CALLED HOME IN STEVENSVILLE LLC
Entity Type:Organization
Organization Name:A PLACE CALLED HOME IN STEVENSVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR/LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:MEAGAN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-876-6523
Mailing Address - Street 1:4167 N ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-9119
Mailing Address - Country:US
Mailing Address - Phone:269-281-0357
Mailing Address - Fax:269-281-0932
Practice Address - Street 1:4167 N ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-9119
Practice Address - Country:US
Practice Address - Phone:269-281-0357
Practice Address - Fax:269-281-0932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAL110405928OtherADULT FOSTER CARE LICENSE NUMBER