Provider Demographics
NPI:1528285111
Name:HOME I.V. CARE
Entity type:Organization
Organization Name:HOME I.V. CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BISMACK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
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:2007-04-18
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X, 251F00000X, 332B00000X, 332BC3200X, 332BD1200X, 332BN1400X, 332BX2000X, 3336H0001X, 335E00000X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI872804497Medicaid
MI540F30963OtherBCBSM SUPPLIER PROVIDER
MI540F30963OtherBCBSM SUPPLIER PROVIDER