Healthcare Provider Details

I. General information

NPI: 1427823889
Provider Name (Legal Business Name): ADVANCE HOMECARE SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24901 NORTHWESTERN HWY STE 303
SOUTHFIELD MI
48075-2208
US

IV. Provider business mailing address

24901 NORTHWESTERN HWY STE 303
SOUTHFIELD MI
48075-2208
US

V. Phone/Fax

Practice location:
  • Phone: 248-728-4169
  • Fax: 248-728-4745
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: THERESA BERGER
Title or Position: PRESIDENT
Credential:
Phone: 248-979-5058