Provider Demographics
NPI:1588363238
Name:OVERALL CARE SUPPORTED SERVICES
Entity type:Organization
Organization Name:OVERALL CARE SUPPORTED SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-544-8695
Mailing Address - Street 1:11480 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-3206
Mailing Address - Country:US
Mailing Address - Phone:313-544-8695
Mailing Address - Fax:
Practice Address - Street 1:11480 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-3206
Practice Address - Country:US
Practice Address - Phone:313-544-8695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9724505Medicaid