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General NPI Number Information
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NPI Number | 1164093126
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Entity Type | Organization
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Legal Business Name | EXECUTIVE CASE MANAGEMENT LLC
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 2203 SHEARWATER CIR
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City | WALLED LAKE
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State | MI
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Zip | 48390-4254
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Country | US
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Telephone | 248-408-0632
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 785
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City | UNION LAKE
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State | MI
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Zip | 48387-0785
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Country | US
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Telephone | 248-408-0632
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAREN FERGUSON TAYLOR
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Credential | RN BSN
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Telephone | 248-408-0632
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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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