Organization
STATELY LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORI COSTANZA RN (OWNER, REGISTERED NURSE)
(269) 757-1504
Entity
Organization
Contact information
Practice address
2824 S STATE ST, SAINT JOSEPH, MI 49085-2478
(269) 757-1504
Mailing address
2824 S STATE ST, SAINT JOSEPH, MI 49085-2478
(269) 757-1504
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
AS110382705
MI
Other
Enumeration date
04/28/2017
Last updated
04/28/2017
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