Organization
HERNANDEZ HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACIE HERNANDEZ (CEO)
(269) 628-2100
Entity
Organization
Contact information
Practice address
94 45TH ST, BLOOMINGDALE, MI 49026-9502
(269) 628-2100
Mailing address
P.O. BOX 277, BLOOMINGDALE, MI 49026
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
AS030282002
MI
Other
Enumeration date
05/12/2011
Last updated
05/12/2011
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