Provider Demographics
NPI:1215023551
Name:FRIENDS WHO CARE-SOUTH HAVEN,LLC
Entity Type:Organization
Organization Name:FRIENDS WHO CARE-SOUTH HAVEN,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:
Authorized Official - Last Name:BUSSELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-968-5540
Mailing Address - Street 1:532 DYCKMAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-2509
Mailing Address - Country:US
Mailing Address - Phone:269-639-7323
Mailing Address - Fax:269-639-7824
Practice Address - Street 1:532 DYCKMAN AVE STE A
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-2509
Practice Address - Country:US
Practice Address - Phone:269-639-7323
Practice Address - Fax:269-639-7824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health