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General NPI Number Information
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NPI Number | 1154551406
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Entity Type | Organization
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Legal Business Name | HEALTH SOURCE HOME CARE INC
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 07/13/2011
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Provider Practice Location Address
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Address Line | 1100 OWENDALE DR SUITE B
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City | TROY
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State | MI
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Zip | 48083-1914
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Country | US
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Telephone | 248-688-9106
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Fax | 248-250-5555
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Provider Business Mailing Address
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Address Line | 1100 OWENDALE DR SUITE B
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City | TROY
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State | MI
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Zip | 48083-1914
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Country | US
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Telephone | 248-688-9106
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Fax | 248-250-5555
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Authorized Official
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Title or Position | PRESIDENT/ADMINISTRATOR
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Name | MR. ROMMEL A PINILI
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Credential | PT
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Telephone | 248-688-9106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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