Healthcare Provider Details

I. General information

NPI: 1205673225
Provider Name (Legal Business Name): ESSENTIAL CARE CASE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35761 SURREY CT
ROMULUS MI
48174-6334
US

IV. Provider business mailing address

PO BOX 2707
BELLEVILLE MI
48112-2707
US

V. Phone/Fax

Practice location:
  • Phone: 269-767-6851
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: SUSAN CATHERMAN
Title or Position: CREDENTIALING
Credential:
Phone: 269-767-6851