Provider Demographics
NPI:1154943603
Name:PROMISSA PERSONALIZED CARE SERVICES LLC
Entity type:Organization
Organization Name:PROMISSA PERSONALIZED CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:517-393-7777
Mailing Address - Street 1:200 E EDGEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911
Mailing Address - Country:US
Mailing Address - Phone:517-393-7777
Mailing Address - Fax:517-393-6920
Practice Address - Street 1:200 E EDGEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911
Practice Address - Country:US
Practice Address - Phone:517-393-7777
Practice Address - Fax:517-393-6920
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROMISSA PERSONALIZED CARE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility