Provider Demographics
NPI:1699435917
Name:CROSS TOWN HOME CARE LLC
Entity type:Organization
Organization Name:CROSS TOWN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR ADVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-837-1048
Mailing Address - Street 1:35748 BIBBINS ST
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-1427
Mailing Address - Country:US
Mailing Address - Phone:248-342-9207
Mailing Address - Fax:
Practice Address - Street 1:35748 BIBBINS ST
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-1427
Practice Address - Country:US
Practice Address - Phone:248-342-9207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home