# LARRY'S FULL SERVICE SALON

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LARRY CLAYBAUGH,JR.
- **Other names:** state of michigan
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1013289438
- **Legal business name:** LARRY CLAYBAUGH,JR.
- **Authorized official:** MR. LARRY EUGENE CLAYBAUGH JR. CAREGIVER (OPPERATOR)
- **Authorized official phone:** (989) 544-2200

## Contact information

- **Practice address:** 10658 ALPINE DR, LAKE, MI 48632-9722
- **Practice address phone:** (989) 544-2200
- **Mailing address:** 10658 ALPINE DR, LAKE, MI 48632-9722
- **Mailing address phone:** (989) 544-2200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 385H00000X | Respite Care | 1865788 | MI | Yes |

## Other

- **Enumeration date:** 01/31/2012
- **Last updated:** 01/31/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1865788 | STATE OF MICHIGAN HOME HELP CARE PROVIDER\#1865788(2003)-PRESENT | MI |