Provider Demographics
NPI:1629303680
Name:ASSISTED RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:ASSISTED RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-686-8331
Mailing Address - Street 1:845 STERN ST
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010
Mailing Address - Country:US
Mailing Address - Phone:269-686-8331
Mailing Address - Fax:269-686-8433
Practice Address - Street 1:845 STERN ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010
Practice Address - Country:US
Practice Address - Phone:269-686-8331
Practice Address - Fax:269-686-8433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty