=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154156420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVOCARE HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2024
-----------------------------------------------------
Last Update Date | 09/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 PARKLANE BLVD STE 525
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48126-4210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-275-1885
-----------------------------------------------------
Fax | 810-391-2263
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 PARKLANE BLVD STE 525
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48126-4210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-275-1885
-----------------------------------------------------
Fax | 810-391-2263
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | JOHN HILLARY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 810-275-1885
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207QG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------