Provider Demographics
NPI:1942865720
Name:HENLYN CARE, INC.
Entity Type:Organization
Organization Name:HENLYN CARE, INC.
Other - Org Name:HENLYN CARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLUM
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:734-545-0188
Mailing Address - Street 1:PO BOX 2562
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-2562
Mailing Address - Country:US
Mailing Address - Phone:734-663-9080
Mailing Address - Fax:734-663-9080
Practice Address - Street 1:1132 CLAIR CIR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3023
Practice Address - Country:US
Practice Address - Phone:734-545-0188
Practice Address - Fax:734-663-9080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No253J00000XAgenciesFoster Care Agency