Provider Demographics
NPI:1417930207
Name:MERCY GENERAL HEALTH PARTNERS AMICARE HOMECARE
Entity type:Organization
Organization Name:MERCY GENERAL HEALTH PARTNERS AMICARE HOMECARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KNITTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-343-6512
Mailing Address - Street 1:P.O. BOX 9185
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-9185
Mailing Address - Country:US
Mailing Address - Phone:734-343-6570
Mailing Address - Fax:734-343-6451
Practice Address - Street 1:888 TERRACE ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440-1220
Practice Address - Country:US
Practice Address - Phone:231-672-4663
Practice Address - Fax:231-672-6263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-25
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI613512251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08791OtherBLUE CROSS & BLUE SHIELD
MI08791OtherBLUE CHOICE
MI800002010OtherPRIORITY HEALTH
MI4271950Medicaid
MI08791OtherBLUE CARE NETWORK
MI30937OtherHEALTH PLAN OF MICHIGAN
MI08791OtherBLUE CROSS & BLUE SHIELD