1033623798 NPI number — HOMELIFE, INC

Table of content: (NPI 1033623798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033623798 NPI number — HOMELIFE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMELIFE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033623798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5420A BECKLEY ROAD, PMB 360
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49015-4181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-660-0854
Provider Business Mailing Address Fax Number:
269-660-0964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10745 SOUTH 12TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHOOLCRAFT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49087-8408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-488-7657
Provider Business Practice Location Address Fax Number:
269-488-7658
Provider Enumeration Date:
11/16/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BRUNS
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
269-660-0854

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  AS390350854 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com