1831249432 NPI number — KELLY HOME CARE SERVICES, INC.

Table of content: (NPI 1831249432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831249432 NPI number — KELLY HOME CARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KELLY HOME CARE SERVICES, 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:
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:
1831249432
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:
999 W BIG BEAVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48084-4716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-362-4444
Provider Business Mailing Address Fax Number:
248-244-5247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
999 W BIG BEAVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48084-4716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-362-4444
Provider Business Practice Location Address Fax Number:
248-244-5247
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WOMBLE
Authorized Official First Name:
MICHELLE (SHELLE)
Authorized Official Middle Name:
R
Authorized Official Title or Position:
BUSINESS UNIT LEADER
Authorized Official Telephone Number:
248-244-4917

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC0055 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X , with the licence number: HC0246 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X , with the licence number: HC0054 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X , with the licence number: HC0056 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X , with the licence number: HCO-07312 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X , with the licence number: HCO-07291 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X , with the licence number: HCO-07145 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X , with the licence number: HCO-07142 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X , with the licence number: IS-355 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X , with the licence number: 044-R-0003 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X , with the licence number: 121-R-0022 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X , with the licence number: 025-R-0009 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X , with the licence number: 003064 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X , with the licence number: 15-2036 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X , with the licence number: 20609096 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 0031086000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 397122 . This is a "ALTCEW BR.6282 SPOKANE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 112182 . This is a "KAISER PERMANENTE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 009213 . This is a "SCAN BR.1481 PASADENA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 3133 . This is a "CITY OF VA BEACH-LOCAL CO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 013531 . This is a "SCAN BR.1585 ORANGE CO." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 015027 . This is a "SCAN BR.1497 CULVER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 11489 . This is a "CUMBERLAND CO, BR.5180" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3408499 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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