Provider Demographics
NPI:1689862518
Name:BRONSON AT HOME
Entity Type:Organization
Organization Name:BRONSON AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, LIFESPAN
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-245-8496
Mailing Address - Street 1:165 WASHINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-2929
Mailing Address - Country:US
Mailing Address - Phone:269-660-3600
Mailing Address - Fax:269-660-3650
Practice Address - Street 1:166 E GOODALE AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-2728
Practice Address - Country:US
Practice Address - Phone:269-660-3600
Practice Address - Fax:269-660-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N78730Medicare PIN