Provider Demographics
NPI:1386489003
Name:THOMAS, PATRICIA ANN (CAREGIVER)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18424 RUNYON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-3828
Mailing Address - Country:US
Mailing Address - Phone:313-784-3887
Mailing Address - Fax:
Practice Address - Street 1:18424 RUNYON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3828
Practice Address - Country:US
Practice Address - Phone:313-784-3887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI9118096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0073121364Medicaid