1164961090 NPI number — CONTINUITY CASE MANAGEMENT SERVICES

Table of content: (NPI 1164961090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164961090 NPI number — CONTINUITY CASE MANAGEMENT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONTINUITY CASE MANAGEMENT SERVICES
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:
1164961090
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20615 FENKELL ST
Provider Second Line Business Mailing Address:
231052
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48223-3778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-550-6629
Provider Business Mailing Address Fax Number:
248-607-6756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24801 5 MILE RD
Provider Second Line Business Practice Location Address:
12
Provider Business Practice Location Address City Name:
REDFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48239-3655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-550-6629
Provider Business Practice Location Address Fax Number:
248-607-6757
Provider Enumeration Date:
02/12/2017

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
SUPRENIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PROFESSIONAL SERVICES
Authorized Official Telephone Number:
866-550-6629

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 163WHO200X . This is a "HOME CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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