1124117023 NPI number — HOLY CROSS CARENET INC

Table of content: (NPI 1124117023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124117023 NPI number — HOLY CROSS CARENET INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLY CROSS CARENET INC
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:
HOLY CROSS REHABILITATION AND NURSING CENTER
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:
1124117023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9184
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48333-9184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-305-7919
Provider Business Mailing Address Fax Number:
248-305-7677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3415 GREENCASTLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURTONSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20866-1715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-388-1400
Provider Business Practice Location Address Fax Number:
301-879-4512
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
248-305-7688

Provider Taxonomy Codes

  • Taxonomy code: 332BN1400X , with the licence number:  15-071 15633 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 404789300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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