Provider Demographics
NPI:1346622867
Name:RESTART VETERANS FOSTER HOME CARE LLC
Entity Type:Organization
Organization Name:RESTART VETERANS FOSTER HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EMELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BESEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-276-1466
Mailing Address - Street 1:2105 LAKEVIEW DR
Mailing Address - Street 2:SUITE # 135
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6754
Mailing Address - Country:US
Mailing Address - Phone:480-276-1466
Mailing Address - Fax:
Practice Address - Street 1:2105 LAKEVIEW DR
Practice Address - Street 2:SUITE # 135
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-6754
Practice Address - Country:US
Practice Address - Phone:480-276-7144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-20
Last Update Date:2015-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities