Provider Demographics
NPI:1104282391
Name:ADL HOME CARE KALAMAZOO, INC.
Entity type:Organization
Organization Name:ADL HOME CARE KALAMAZOO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:269-373-5444
Mailing Address - Street 1:4230 S WESTNEDGE AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3291
Mailing Address - Country:US
Mailing Address - Phone:269-373-5444
Mailing Address - Fax:269-373-5441
Practice Address - Street 1:4230 S WESTNEDGE AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3291
Practice Address - Country:US
Practice Address - Phone:269-373-5444
Practice Address - Fax:269-373-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704123001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health