Healthcare Provider Details

I. General information

NPI: 1114691631
Provider Name (Legal Business Name): THOMAS CHARLES KELLING HHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2021
Last Update Date: 08/07/2021
Certification Date: 08/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1346 BARNES DR
WHITTEMORE MI
48770-9406
US

IV. Provider business mailing address

589 S MILL STATION RD
WHITTEMORE MI
48770-9757
US

V. Phone/Fax

Practice location:
  • Phone: 989-305-8357
  • Fax:
Mailing address:
  • Phone: 989-254-5236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: