Healthcare Provider Details

I. General information

NPI: 1821196742
Provider Name (Legal Business Name): CARE SOURCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8232 GRAPHIC DR NE
BELMONT MI
49306-9448
US

IV. Provider business mailing address

8232 GRAPHIC DR NE
BELMONT MI
49306-9448
US

V. Phone/Fax

Practice location:
  • Phone: 616-866-0044
  • Fax: 616-866-9684
Mailing address:
  • Phone: 616-866-0044
  • Fax: 616-866-9684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. MITCHELL ROY MOORE
Title or Position: GM
Credential:
Phone: 616-957-1490