Provider Demographics
NPI:1487335741
Name:28230 SOMERSET RESIDENCE LLC
Entity type:Organization
Organization Name:28230 SOMERSET RESIDENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:313-473-0042
Mailing Address - Street 1:28230 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1167
Mailing Address - Country:US
Mailing Address - Phone:313-473-0042
Mailing Address - Fax:
Practice Address - Street 1:28230 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1167
Practice Address - Country:US
Practice Address - Phone:313-473-0042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency