Provider Demographics
NPI:1740017748
Name:CLOSE TO HOME ASSISTED LIVING ESU
Entity type:Organization
Organization Name:CLOSE TO HOME ASSISTED LIVING ESU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DELEVAN
Authorized Official - Last Name:WINDEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:989-316-2697
Mailing Address - Street 1:805 E SOUTH UNION ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-4895
Mailing Address - Country:US
Mailing Address - Phone:989-316-2697
Mailing Address - Fax:989-439-1039
Practice Address - Street 1:805 E SOUTH UNION ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-4895
Practice Address - Country:US
Practice Address - Phone:989-316-2697
Practice Address - Fax:989-439-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility