Provider Demographics
NPI:1790294064
Name:REDBUD HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:REDBUD HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-409-8626
Mailing Address - Street 1:500 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:MI
Mailing Address - Zip Code:49107-1404
Mailing Address - Country:US
Mailing Address - Phone:269-409-8626
Mailing Address - Fax:269-273-8457
Practice Address - Street 1:500 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:MI
Practice Address - Zip Code:49107-1404
Practice Address - Country:US
Practice Address - Phone:269-409-8626
Practice Address - Fax:269-273-8457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1790294064Medicaid