1871852533 NPI number — PRIMARY CARE HOME SERVICES, INC

Table of content: (NPI 1871852533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871852533 NPI number — PRIMARY CARE HOME SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY CARE HOME 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:
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:
1871852533
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2990 W GRAND BLVD
Provider Second Line Business Mailing Address:
SUITE 307
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48202-3041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-870-9260
Provider Business Mailing Address Fax Number:
313-870-9266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2990 W GRAND BLVD
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48202-3041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-870-9260
Provider Business Practice Location Address Fax Number:
313-870-9266
Provider Enumeration Date:
05/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GOUDY-EGGER
Authorized Official First Name:
LAYNETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
313-870-9260

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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