Healthcare Provider Details

I. General information

NPI: 1538524046
Provider Name (Legal Business Name): INTRICATE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15919 W 10 MILE RD SUITE 208
SOUTHFIELD MI
48075-2035
US

IV. Provider business mailing address

15919 W 10 MILE RD SUITE 208
SOUTHFIELD MI
48075-2035
US

V. Phone/Fax

Practice location:
  • Phone: 248-991-7929
  • Fax:
Mailing address:
  • Phone: 248-469-5438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY D WILLIAMS
Title or Position: OWNER
Credential:
Phone: 248-991-7929