Provider Demographics
NPI:1265719116
Name:MORRELL'S FAMILY HOME
Entity type:Organization
Organization Name:MORRELL'S FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PILLARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-692-2400
Mailing Address - Street 1:1212 110TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:MI
Mailing Address - Zip Code:49070-9721
Mailing Address - Country:US
Mailing Address - Phone:269-692-2400
Mailing Address - Fax:269-692-6020
Practice Address - Street 1:1212 110TH AVE
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:MI
Practice Address - Zip Code:49070-9721
Practice Address - Country:US
Practice Address - Phone:269-692-2400
Practice Address - Fax:269-692-6020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF030293174385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care