Provider Demographics
NPI:1790441566
Name:ISLAND ENTERPRISES LLC
Entity Type:Organization
Organization Name:ISLAND ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH ESQ
Authorized Official - Phone:734-258-8896
Mailing Address - Street 1:2268 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-4136
Mailing Address - Country:US
Mailing Address - Phone:734-258-8896
Mailing Address - Fax:
Practice Address - Street 1:2268 10TH ST
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4136
Practice Address - Country:US
Practice Address - Phone:734-258-8896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care