Provider Demographics
NPI:1306359005
Name:HOMELIFE, INC.
Entity Type:Organization
Organization Name:HOMELIFE, INC.
Other - Org Name:9445 N. 24TH STREET AFC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRUNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-660-0854
Mailing Address - Street 1:5420A BECKLEY ROAD, PMB 360
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4181
Mailing Address - Country:US
Mailing Address - Phone:269-660-0854
Mailing Address - Fax:269-660-0964
Practice Address - Street 1:9445 N 24TH ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MI
Practice Address - Zip Code:49083-9515
Practice Address - Country:US
Practice Address - Phone:269-488-0024
Practice Address - Fax:269-488-0025
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOMELIFE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS390281218320800000X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities