Provider Demographics
NPI:1427478825
Name:CHARLIE K ENTERPRISES, INC
Entity type:Organization
Organization Name:CHARLIE K ENTERPRISES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:KLAWUHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-321-2704
Mailing Address - Street 1:10360 LAUREL WOODS PL
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-8941
Mailing Address - Country:US
Mailing Address - Phone:989-321-2704
Mailing Address - Fax:877-817-5308
Practice Address - Street 1:143 S 1ST ST STE B
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-2500
Practice Address - Country:US
Practice Address - Phone:989-321-2704
Practice Address - Fax:893-212-7049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care