Healthcare Provider Details

I. General information

NPI: 1043350416
Provider Name (Legal Business Name): SOUTHWEST MICHIGAN HOME CARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6633 RED ARROW HWY
COLOMA MI
49038-8717
US

IV. Provider business mailing address

6633 RED ARROW HWY
COLOMA MI
49038-8717
US

V. Phone/Fax

Practice location:
  • Phone: 269-468-7142
  • Fax: 269-468-7143
Mailing address:
  • Phone: 269-468-7142
  • Fax: 269-468-7143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. GERARDO BAS MADANGUIT
Title or Position: PRESIDENT
Credential: BSBA
Phone: 269-468-7142