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General NPI Number Information
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NPI Number | 1194815837
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Entity Type | Organization
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Legal Business Name | INDEPENDENT COMMUNITY CARE SERVICES
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 12/05/2013
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Provider Practice Location Address
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Address Line | 21111 MIDDLEBELT RD
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-5549
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Country | US
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Telephone | 248-476-0583
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Fax | 248-476-0586
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Provider Business Mailing Address
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Address Line | 21111 MIDDLEBELT RD
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-5549
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Country | US
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Telephone | 248-476-0583
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Fax | 248-476-0586
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | JANNICE CRAWFORD
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Credential |
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Telephone | 248-476-0583
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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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