Provider Demographics
NPI:1194965343
Name:INDEPENDENT HOME CARE OF MICHIGAN LLC
Entity type:Organization
Organization Name:INDEPENDENT HOME CARE OF MICHIGAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:RN CCM
Authorized Official - Phone:810-750-2713
Mailing Address - Street 1:13280 OLD OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9497
Mailing Address - Country:US
Mailing Address - Phone:810-750-2713
Mailing Address - Fax:810-714-2386
Practice Address - Street 1:13280 OLD OAKS DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-9497
Practice Address - Country:US
Practice Address - Phone:810-750-2713
Practice Address - Fax:810-714-2386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-01
Last Update Date:2009-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251B00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management