1831232008 NPI number — HOMECARE NETWORK OF MICHIGAN INC.

Table of content: CHEYENNE WOOD OTR, OTD (NPI 1750128112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831232008 NPI number — HOMECARE NETWORK OF MICHIGAN INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMECARE NETWORK OF MICHIGAN INC.
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:
1831232008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29501 GREENFIELD RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48076-2250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-752-3015
Provider Business Mailing Address Fax Number:
248-559-9378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29501 GREENFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48076-2250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-752-3015
Provider Business Practice Location Address Fax Number:
248-559-9378
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
IMRAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
248-752-3015

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)





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