1770554677 NPI number — SAINT MARY'S AMICARE HOME HEALTHCARE

Table of content: (NPI 1770554677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770554677 NPI number — SAINT MARY'S AMICARE HOME HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT MARY'S AMICARE HOME HEALTHCARE
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:
6
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:
1770554677
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 532020
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48153-2020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-827-0788
Provider Business Mailing Address Fax Number:
734-343-6451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1430 MONROE NW
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-685-8800
Provider Business Practice Location Address Fax Number:
616-685-8807
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOWENS
Authorized Official First Name:
MARCUS
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
770-283-4006

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: OE137 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3445128 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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