Provider Demographics
NPI:1609031251
Name:CARE & COMFORT STATION
Entity Type:Organization
Organization Name:CARE & COMFORT STATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/WOUND SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUDY
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:586-777-0593
Mailing Address - Street 1:22777 HARPER AVE
Mailing Address - Street 2:SUITE 103 A
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1868
Mailing Address - Country:US
Mailing Address - Phone:586-777-0593
Mailing Address - Fax:586-779-3282
Practice Address - Street 1:22777 HARPER AVE
Practice Address - Street 2:SUITE 103 A
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1868
Practice Address - Country:US
Practice Address - Phone:586-777-0593
Practice Address - Fax:586-779-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704114991251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1841282753OtherNPI