Provider Demographics
NPI:1427268135
Name:HOME I V CARE INC
Entity type:Organization
Organization Name:HOME I V CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:BISMACK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MBA
Authorized Official - Phone:248-577-5670
Mailing Address - Street 1:32751 EDWARD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1422
Mailing Address - Country:US
Mailing Address - Phone:248-577-5670
Mailing Address - Fax:248-577-5660
Practice Address - Street 1:32751 EDWARD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1422
Practice Address - Country:US
Practice Address - Phone:248-577-5670
Practice Address - Fax:248-577-5660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336S0011X
MI53010059473336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2354998Medicaid
2354998OtherNCPDP PROVIDER IDENTIFICATION NUMBER