Provider Demographics
NPI:1235964867
Name:BAILEYS HOME FOR THE AGED, LLC
Entity type:Organization
Organization Name:BAILEYS HOME FOR THE AGED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-625-7403
Mailing Address - Street 1:24755 HILL AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-4459
Mailing Address - Country:US
Mailing Address - Phone:586-625-7403
Mailing Address - Fax:
Practice Address - Street 1:24755 HILL AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-4459
Practice Address - Country:US
Practice Address - Phone:586-625-7403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health