Provider Demographics
NPI:1447682158
Name:SELECT RESIDENTIAL SOLUTIONS L.L.C.
Entity type:Organization
Organization Name:SELECT RESIDENTIAL SOLUTIONS L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELECT RESIDENTIAL-OWNER/LICENSEE R
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:DANIELS
Authorized Official - Last Name:STURDEVANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-579-3623
Mailing Address - Street 1:P.O. BOX 302
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068
Mailing Address - Country:US
Mailing Address - Phone:269-579-3629
Mailing Address - Fax:269-962-1301
Practice Address - Street 1:1100 W. HIGHLAND BLVD.
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015
Practice Address - Country:US
Practice Address - Phone:269-579-3623
Practice Address - Fax:269-962-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness