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General NPI Number Information
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NPI Number | 1114314366
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Entity Type | Organization
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Legal Business Name | MANAGED SENIOR CARE LLC
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 04/24/2015
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Provider Practice Location Address
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Address Line | 625 SPRING AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1903
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Country | US
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Telephone | 616-234-0190
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Fax | 866-289-0994
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Provider Business Mailing Address
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Address Line | PO BOX 140288
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City | GRAND RAPIDS
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State | MI
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Zip | 49514-0288
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Country | US
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Telephone | 616-234-0190
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Fax | 866-289-0994
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Authorized Official
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Title or Position | CO-OWNER
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Name | MRS. DANNA GOMEZ
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Credential |
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Telephone | 616-234-0190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #4
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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 |
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