Healthcare Provider Details

I. General information

NPI: 1467903005
Provider Name (Legal Business Name): SPECIALIZED HOMECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4103 GRAND OAK DR STE B111
LANSING MI
48911-7406
US

IV. Provider business mailing address

1535 HIGHWOOD E
PONTIAC MI
48340-1234
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3000
  • Fax: 517-882-3013
Mailing address:
  • Phone: 877-944-9800
  • Fax: 248-409-0403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARLIA CICHON
Title or Position: PRESIDENT
Credential:
Phone: 877-944-9800