Organization
COUNTRY CLUB HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE MARIE MANSEL R.N. (PRESIDENT)
(248) 626-8500
Entity
Organization
Contact information
Practice address
4120 W MAPLE RD, SUITE 201, BLOOMFIELD HILLS, MI 48301-3010
(248) 626-8500
(248) 539-9740
Mailing address
4120 W MAPLE RD, SUITE 201, BLOOMFIELD HILLS, MI 48301-3010
(248) 626-8500
(248) 539-9740
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
03/16/2009
Last updated
03/16/2009
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