Healthcare Provider Details

I. General information

NPI: 1164520086
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

96 S SEAWAY DR
MUSKEGON HEIGHTS MI
49444-3841
US

IV. Provider business mailing address

96 S SEAWAY DR
MUSKEGON HEIGHTS MI
49444-3841
US

V. Phone/Fax

Practice location:
  • Phone: 231-739-3436
  • Fax: 231-739-3367
Mailing address:
  • Phone: 231-739-3436
  • Fax: 231-739-3367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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