1518110600 NPI number — GENUINE CARE, INC.

Table of content: (NPI 1518110600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518110600 NPI number — GENUINE CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENUINE CARE, 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:
COMFORCARE HOME CARE MACOMB/ST. CLAIR
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:
1518110600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35519 23 MILE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BALTIMORE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48047-3603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-725-0005
Provider Business Mailing Address Fax Number:
586-725-1009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35519 23 MILE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BALTIMORE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48047-3603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-725-0005
Provider Business Practice Location Address Fax Number:
586-725-1009
Provider Enumeration Date:
11/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VANDERBURG
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR/OWNER
Authorized Official Telephone Number:
586-725-0005

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 9541226 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9541226 . This is a "DEPARTMENT OF HUMAN SERVICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com