1114393253 NPI number — UNIQUE IN HOME CARE SERVICES LLC

Table of content: (NPI 1114393253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114393253 NPI number — UNIQUE IN HOME CARE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIQUE IN HOME CARE SERVICES LLC
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:
Provider Other Organization Name Type Code:
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:
1114393253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40151
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48240-0151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-466-4091
Provider Business Mailing Address Fax Number:
313-740-7458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19964 ROGGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48234-3031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-466-4091
Provider Business Practice Location Address Fax Number:
313-543-3172
Provider Enumeration Date:
08/12/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CROSBY
Authorized Official First Name:
CHALVONTE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
313-315-0151

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7809391 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".