Healthcare Provider Details

I. General information

NPI: 1881843407
Provider Name (Legal Business Name): SSAC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 HIGHWAY 15 S
JACKSON KY
41339-9602
US

IV. Provider business mailing address

26777 CENTRAL PARK BLVD SUITE 200
SOUTHFIELD MI
48076-4162
US

V. Phone/Fax

Practice location:
  • Phone: 866-666-8310
  • Fax:
Mailing address:
  • Phone: 248-352-7530
  • Fax: 248-352-5189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number128972
License Number StateKY

VIII. Authorized Official

Name: CATHY SPARLING
Title or Position: SR. VP ADMINISTRATIVE SERVICES
Credential:
Phone: 248-352-7530