Provider Demographics
NPI:1922558329
Name:REFLECTIONS OF THURSTON WOODS
Entity Type:Organization
Organization Name:REFLECTIONS OF THURSTON WOODS
Other - Org Name:ADULT FOSTER CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:THEO
Authorized Official - Middle Name:
Authorized Official - Last Name:OMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-651-7841
Mailing Address - Street 1:307 N. FRANKS AVE.
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091
Mailing Address - Country:US
Mailing Address - Phone:269-651-7841
Mailing Address - Fax:
Practice Address - Street 1:1946 S. THURSTON WOODS DRIVE
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091
Practice Address - Country:US
Practice Address - Phone:269-319-6505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THURSTON WOODS VILLAGE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM750378700311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home