Organization Name: | GREAT LIVING FOSTER CARE |
NPI Number: | 1487066734 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BERGELINE FLORVILUS (MANAGER) |
Mailing Address: | 8973 Pioneer Ct Berrien Springs |
State: | MI US |
Postal Code: | 491031700 |
Phone Number: | 2698152087 |
Fax Number: | 2698155064 |
NPI Enumeration Date: | 05/21/2014 |
NPI Last Update Date: | 05/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320800000X |
License Number: | AF110317417 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |