Provider Demographics
NPI:1588994065
Name:CAMPBELLS PERSONAL CARE HOME #4, INC.
Entity type:Organization
Organization Name:CAMPBELLS PERSONAL CARE HOME #4, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGHER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:VAUBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-245-9400
Mailing Address - Street 1:PO BOX 821
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-0821
Mailing Address - Country:US
Mailing Address - Phone:810-245-9400
Mailing Address - Fax:
Practice Address - Street 1:1900 LAKEVILLE RD
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:MI
Practice Address - Zip Code:48367-3306
Practice Address - Country:US
Practice Address - Phone:248-628-6348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL630015496310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAL630015496OtherSTATE OF MICHIGAN DEPARTMENT OF HUMAN SERVICES