Provider Demographics
NPI:1194322628
Name:ALBACARE LLC
Entity type:Organization
Organization Name:ALBACARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTONETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DJELJEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-751-3652
Mailing Address - Street 1:2755 PALL MALL DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5808
Mailing Address - Country:US
Mailing Address - Phone:917-751-3652
Mailing Address - Fax:
Practice Address - Street 1:2755 PALL MALL DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5808
Practice Address - Country:US
Practice Address - Phone:917-751-3652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care