Provider Demographics
NPI:1629384052
Name:COMFORCARE SENIOR SERVICES - GRAND HAVEN
Entity Type:Organization
Organization Name:COMFORCARE SENIOR SERVICES - GRAND HAVEN
Other - Org Name:PERSONALIZED HOME CARE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LYON
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:616-402-9444
Mailing Address - Street 1:11852 JUNIPER HILLS CT
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-9367
Mailing Address - Country:US
Mailing Address - Phone:616-842-2618
Mailing Address - Fax:
Practice Address - Street 1:41 WASHINGTON AVE STE 380
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-3318
Practice Address - Country:US
Practice Address - Phone:616-842-2618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care