Stately Living, LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

AS110382705 Issued in MI

Legal business name

STATELY LIVING, LLC

Practice address

2824 S State St
Saint Joseph, MI 49085-2478

Phone

(269) 757-1504

NPI assigned

Apr 28, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lori Costanza, RN

Title

Owner, Registered Nurse

Phone

(269) 757-1504

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1493337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493337600000",
    "number": "1215462064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2824 S STATE ST",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490852478",
            "telephone_number": "269-757-1504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2824 S STATE ST",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490852478",
            "telephone_number": "269-757-1504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATELY LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-28",
        "last_updated": "2017-04-28",
        "status": "A",
        "authorized_official_last_name": "COSTANZA",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "OWNER, REGISTERED NURSE",
        "authorized_official_telephone_number": "269-757-1504",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MI",
            "license": "AS110382705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tatiyana Stankovic, MSN, FNP
• Annabelle Marie Staples, DO
• Margaret O. Stark, N.P.
• George T Starrett, EDD
• Susan L Startup, LMSW
• Robert Allen Stauffer, CMMT
• Ryan J Steele, OTRL
• Christianna Nicole Steely
• Zachariah Luke Steffen
• Jessica Steinacker

• Adult Care Home Facility in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Adult Care Home Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.