Provider Demographics
NPI:1487392049
Name:CLARA'S HOUSE 2 LLC
Entity type:Organization
Organization Name:CLARA'S HOUSE 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JOSEPHSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-391-5783
Mailing Address - Street 1:10111 ISLAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-9594
Mailing Address - Country:US
Mailing Address - Phone:734-391-5783
Mailing Address - Fax:734-426-2269
Practice Address - Street 1:7415 DEXTER PINCKNEY RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-7505
Practice Address - Country:US
Practice Address - Phone:734-391-5783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home