# COUNTRY CLUB HOME CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629219910
- **Authorized official:** ROSE MARIE MANSEL R.N. (PRESIDENT)
- **Authorized official phone:** (248) 626-8500

## Contact information

- **Practice address:** 4120 W MAPLE RD, SUITE 201, BLOOMFIELD HILLS, MI 48301-3010
- **Practice address phone:** (248) 626-8500
- **Practice address fax:** (248) 539-9740
- **Mailing address:** 4120 W MAPLE RD, SUITE 201, BLOOMFIELD HILLS, MI 48301-3010
- **Mailing address phone:** (248) 626-8500
- **Mailing address fax:** (248) 539-9740

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 03/16/2009
- **Last updated:** 03/16/2009