Provider Demographics
NPI:1699284638
Name:BOMMARTIO, GIUSEPPINA
Entity type:Individual
Prefix:
First Name:GIUSEPPINA
Middle Name:
Last Name:BOMMARTIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16004 TULIP DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-5806
Mailing Address - Country:US
Mailing Address - Phone:586-992-2669
Mailing Address - Fax:
Practice Address - Street 1:16004 TULIP DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-5806
Practice Address - Country:US
Practice Address - Phone:586-992-2669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF500286925320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities