MEDICARE: PRN CARE TEAM, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	251F00000X	Home Infusion Agency
3	251J00000X	Nursing Care Agency
4	261QC1500X	Community Health Clinic/Center
5	261QU0200X	Urgent Care Clinic/Center
6	363LA2200X	Adult Health Nurse Practitioner
7	363LG0600X	Gerontology Nurse Practitioner
8	363LP2300X	Primary Care Nurse Practitioner
9	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1215684410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRN CARE TEAM, LLC

Provider Business Mailing Address
First Line	:	4303 WOODHALL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-2222
Country	:	US
Telephone Number	:	313-671-3252
Fax Number	:	563-227-4013

Provider Business Practice Location Address
First Line	:	2328 E 7 MILE RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-1304
Country	:	US
Telephone Number	:	313-913-8736
Fax Number	:	563-227-4013

Authorized Official
Title or Position	:	MANAGER
Name	:	YVONNE TAYLOR
Credential	:	NP
Telephone Number	:	313-671-3252

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	03/09/2022

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