Provider Demographics
NPI:1275620692
Name:FRIENDS WHO CARE-MANISTEE, LLC
Entity Type:Organization
Organization Name:FRIENDS WHO CARE-MANISTEE, 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 1:318 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2742
Mailing Address - Country:US
Mailing Address - Phone:231-723-4181
Mailing Address - Fax:231-723-7780
Practice Address - Street 1:318 RIVER ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2742
Practice Address - Country:US
Practice Address - Phone:231-723-4181
Practice Address - Fax:231-723-7780
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRIENDS WHO CARE,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI15 4364183Medicaid
MI15 4364183Medicaid