1437182714 NPI number — FRESH PERSPECTIVE HOME CARE LLC

Table of content: (NPI 1437182714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437182714 NPI number — FRESH PERSPECTIVE HOME CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRESH PERSPECTIVE HOME CARE LLC
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:
1437182714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31785 PAWTON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAW PAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-329-4717
Provider Business Mailing Address Fax Number:
269-329-4716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7127 S. WESTNEDGE AVE
Provider Second Line Business Practice Location Address:
STE #5A
Provider Business Practice Location Address City Name:
PORTAGE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-329-4717
Provider Business Practice Location Address Fax Number:
269-329-4716
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CONNER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
L
Authorized Official Title or Position:
GENERAL MANAGER/MEMBER
Authorized Official Telephone Number:
269-330-2397

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , 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: 7199523 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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