Healthcare Provider Details

I. General information

NPI: 1154156420
Provider Name (Legal Business Name): AVOCARE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 PARKLANE BLVD STE 525
DEARBORN MI
48126-4210
US

IV. Provider business mailing address

6 PARKLANE BLVD STE 525
DEARBORN MI
48126-4210
US

V. Phone/Fax

Practice location:
  • Phone: 810-275-1885
  • Fax: 810-391-2263
Mailing address:
  • Phone: 810-275-1885
  • Fax: 810-391-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN HILLARY
Title or Position: CFO
Credential:
Phone: 810-275-1885