Healthcare Provider Details

I. General information

NPI: 1780782607
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

2605 S CLEVELAND AVE
SAINT JOSEPH MI
49085-3001
US

IV. Provider business mailing address

2605 S CLEVELAND AVE
SAINT JOSEPH MI
49085-3001
US

V. Phone/Fax

Practice location:
  • Phone: 269-429-5900
  • Fax: 269-429-0092
Mailing address:
  • Phone: 269-429-5900
  • Fax: 269-429-0092

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. MARK A PIERSMA
Title or Position: PRESIDENT
Credential:
Phone: 616-957-3957