Provider Demographics
NPI:1407526627
Name:EMMAUS CORPORATION
Entity Type:Organization
Organization Name:EMMAUS CORPORATION
Other - Org Name:HAVEN OF REST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TRYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-410-8249
Mailing Address - Street 1:1600 E GRAND RIVER AVE OFC
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3910
Mailing Address - Country:US
Mailing Address - Phone:517-410-8249
Mailing Address - Fax:
Practice Address - Street 1:2447 N WILLIAMSTON RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:MI
Practice Address - Zip Code:48895-9462
Practice Address - Country:US
Practice Address - Phone:517-655-8953
Practice Address - Fax:517-655-8954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-18
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency