1134306046 NPI number — MYMICHIGAN HOME CARE

Table of content: (NPI 1134306046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134306046 NPI number — MYMICHIGAN HOME CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MYMICHIGAN HOME CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MIDMICHIGAN HOME CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134306046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6810 EASTMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48642-7805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-633-1400
Provider Business Mailing Address Fax Number:
989-633-1412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6810 EASTMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48642-7805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-633-1400
Provider Business Practice Location Address Fax Number:
989-633-1412
Provider Enumeration Date:
01/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MELCHI
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PATIENT ACCOUNTING MANAGER
Authorized Official Telephone Number:
989-633-0746

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 540E611180 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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