Healthcare Provider Details

I. General information

NPI: 1366825481
Provider Name (Legal Business Name): DIRECT CARE SOLUTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26070 CONTINENTAL CIR
TAYLOR MI
48180-6901
US

IV. Provider business mailing address

26070 CONTINENTAL CIR
TAYLOR MI
48180-6901
US

V. Phone/Fax

Practice location:
  • Phone: 734-334-0077
  • Fax: 734-374-0421
Mailing address:
  • Phone: 734-334-0077
  • Fax: 734-374-0421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number4703113460
License Number StateMI

VIII. Authorized Official

Name: TONISHA M BLACKMAN
Title or Position: NURSE
Credential: LPN
Phone: 734-334-0077