Provider Demographics
NPI:1104053123
Name:CARE COMMUITY
Entity type:Organization
Organization Name:CARE COMMUITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-968-3365
Mailing Address - Street 1:565 GENERAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49037-7553
Mailing Address - Country:US
Mailing Address - Phone:269-968-3365
Mailing Address - Fax:269-968-2446
Practice Address - Street 1:565 GENERAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MI
Practice Address - Zip Code:49037-7553
Practice Address - Country:US
Practice Address - Phone:269-968-3365
Practice Address - Fax:269-968-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAH130254365310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0323398Medicaid