1326002577 NPI number — MUNSON HOME CARE

Table of content: (NPI 1326002577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326002577 NPI number — MUNSON HOME CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MUNSON HOME CARE
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:
1326002577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1105 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRAVERSE CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49684-2349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-935-6520
Provider Business Mailing Address Fax Number:
231-935-9116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 MUNSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRAVERSE CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49686-3580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-935-6520
Provider Business Practice Location Address Fax Number:
866-380-0564
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
SHARI
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
231-935-8432

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: DP0734 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P24420007 . This is a "WPS- MEDICARE- DR. DIANE PARSONS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P24420008 . This is a "WPS- MEDICARE JULIE HARTL NP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P24420005 . This is a "WPS- MEDICARE DONNA NELSON NP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0E003 . This is a "BCBS OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P24420009 . This is a "WPS MEDICARE PC - ALYCIA RHEIN NP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P24420009 . This is a "WPS MEDICARE PC- GRETA PECK PA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4217366 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500B814150 . This is a "BLUE CROSS GROUP PRACTICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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