=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346665940
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTAL CARE PLUS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2014
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3899 24TH AVE SUITE 1
-----------------------------------------------------
City | FORT GRATIOT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48059-4101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-990-8950
-----------------------------------------------------
Fax | 810-990-8952
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3899 24TH AVE SUITE 1
-----------------------------------------------------
City | FORT GRATIOT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48059-4101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-990-8950
-----------------------------------------------------
Fax | 810-990-8952
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | LEEANN MICHELLE WHITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 810-858-7963
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 385HR2050X
-----------------------------------------------------
Taxonomy Name | Respite Care Camp
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------