# COUNTRY CLUB HOME CARE LLC

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

## Provider details

- **NPI number:** 1871896456
- **Authorized official:** MS. ROSE MARIE MANSEL REGISTERED NURSE (OWNER)
- **Authorized official phone:** (248) 346-1233

## Contact information

- **Practice address:** 6477 HERITAGE, WEST BLOOMFIELD, MI 48322-1339
- **Practice address phone:** (866) 596-9111
- **Practice address fax:** (866) 596-9111
- **Mailing address:** 2554 S ROCHESTER RD, ROCHESTER HILLS, MI 48307-3817
- **Mailing address phone:** (866) 596-9111
- **Mailing address fax:** (866) 596-9111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 4704245086 | MI | Yes |

## Other

- **Enumeration date:** 12/21/2010
- **Last updated:** 12/21/2010