=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467043752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PURE UNITED CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2021
-----------------------------------------------------
Last Update Date | 09/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 W BIG BEAVER RD STE 200
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48084-5283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-423-2608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4552 OREGON ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48204-3617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-277-6912
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRSIDENT
-----------------------------------------------------
Name | FAY LAUREE DARRELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-423-2608
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------