1760708184 NPI number — RIVERVIEW MACOMB HOME & ATTENDANT CARE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760708184 NPI number — RIVERVIEW MACOMB HOME & ATTENDANT CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERVIEW MACOMB HOME & ATTENDANT 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:
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:
1760708184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 183667
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELBY TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48318-3667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-566-7343
Provider Business Mailing Address Fax Number:
586-758-7801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37060 GARFIELD RD
Provider Second Line Business Practice Location Address:
STE C-1
Provider Business Practice Location Address City Name:
CLINTON TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48036-3647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-566-7343
Provider Business Practice Location Address Fax Number:
586-758-7801
Provider Enumeration Date:
04/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MURRAY
Authorized Official First Name:
MARCUS
Authorized Official Middle Name:
LACRAIG
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
586-566-7343

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  4704169199 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , with the licence number: 4704169199 , 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)





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