Provider Demographics
NPI:1730276957
Name:FRIENDS WHO CARE-HILLSDALE, LLC
Entity type:Organization
Organization Name:FRIENDS WHO CARE-HILLSDALE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSSELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-968-5540
Mailing Address - Street 1:25900 GREENFIELD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1267
Mailing Address - Country:US
Mailing Address - Phone:248-968-5540
Mailing Address - Fax:248-968-5621
Practice Address - Street 1:25900 GREENFIELD RD STE 105
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1267
Practice Address - Country:US
Practice Address - Phone:248-968-5540
Practice Address - Fax:248-968-5621
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRIENDS WHO CARE,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-09
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI15 4360729Medicaid