Healthcare Provider Details

I. General information

NPI: 1528491438
Provider Name (Legal Business Name): ALTUM CARE HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23408 PLUM HOLLOW ST
SOUTHFIELD MI
48033-3275
US

IV. Provider business mailing address

23408 PLUM HOLLOW ST
SOUTHFIELD MI
48033-3275
US

V. Phone/Fax

Practice location:
  • Phone: 248-809-6202
  • Fax:
Mailing address:
  • Phone: 248-809-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberAS630332450
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberAS630332450
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberAS630332450
License Number StateMI

VIII. Authorized Official

Name: RONDA FREEMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 313-377-3776