1760541858 NPI number — EMPICARE, INC.

Table of content: (NPI 1760541858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760541858 NPI number — EMPICARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMPICARE, 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:
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:
1760541858
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11802 BRINLEY AVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40243-1089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-244-2774
Provider Business Mailing Address Fax Number:
502-244-8085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
183 PEACE BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAINT JOSEPH
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49085-9146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-429-5671
Provider Business Practice Location Address Fax Number:
269-429-5671
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TRASK
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
DIANNE
Authorized Official Title or Position:
VICE PRESIDENT, CORPORATE DEVELOPME
Authorized Official Telephone Number:
502-244-2774

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  U ME-0149319 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 335E00000X , with the licence number: U ME-0149319 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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