Provider Demographics
NPI:1972601896
Name:CARE SOURCE, INC
Entity type:Organization
Organization Name:CARE SOURCE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIERSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-957-3957
Mailing Address - Street 1:1511 E CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-1991
Mailing Address - Country:US
Mailing Address - Phone:269-651-3266
Mailing Address - Fax:269-651-6924
Practice Address - Street 1:1511 E CHICAGO RD
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1991
Practice Address - Country:US
Practice Address - Phone:269-651-3266
Practice Address - Fax:269-651-6924
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARE SOURCE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1891743258Medicaid
MI1891743258Medicaid