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General NPI Number Information
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NPI Number | 1063317253
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Entity Type | Organization
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Legal Business Name | IMPACT CARE GROUP
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | 25750 STONYCROFT DR
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City | SOUTHFIELD
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State | MI
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Zip | 48033-5888
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Country | US
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Telephone | 248-470-0299
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Fax |
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Provider Business Mailing Address
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Address Line | 25750 STONYCROFT DR
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City | SOUTHFIELD
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State | MI
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Zip | 48033-5888
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Country | US
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Telephone | 248-470-0299
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MRS. DORETHA JEHAN ROSS
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Credential |
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Telephone | 248-470-0299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | NULL
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