Provider Demographics
NPI:1700973112
Name:FRIENDS WHO CARE-JACKSON, LLC
Entity Type:Organization
Organization Name:FRIENDS WHO CARE-JACKSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSSELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-968-5540
Mailing Address - Street 1:115 S WEST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2085
Mailing Address - Country:US
Mailing Address - Phone:517-787-5710
Mailing Address - Fax:517-787-9855
Practice Address - Street 1:115 S WEST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2085
Practice Address - Country:US
Practice Address - Phone:517-787-5710
Practice Address - Fax:517-787-9855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health