Organization
COUNTRY CLUB HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ROSE MARIE MANSEL REGISTERED NURSE (OWNER)
(248) 346-1233
Entity
Organization
Contact information
Practice address
6477 HERITAGE, WEST BLOOMFIELD, MI 48322-1339
(866) 596-9111
(866) 596-9111
Mailing address
2554 S ROCHESTER RD, ROCHESTER HILLS, MI 48307-3817
(866) 596-9111
(866) 596-9111
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
4704245086
MI
Other
Enumeration date
12/21/2010
Last updated
12/21/2010
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