Provider Demographics
NPI:1992402911
Name:ULTICARE INC
Entity type:Organization
Organization Name:ULTICARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:C
Authorized Official - Middle Name:
Authorized Official - Last Name:IZUEGBUNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-579-5700
Mailing Address - Street 1:38972 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-6305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38972 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-6305
Practice Address - Country:US
Practice Address - Phone:313-579-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health