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General NPI Number Information
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NPI Number | 1609271105
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Entity Type | Organization
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Legal Business Name | MYCARE HEALTH CENTER
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 1400 E12 MILE ROAD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071
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Country | US
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Telephone | 248-658-1116
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Fax |
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Provider Business Mailing Address
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Address Line | 6800 E 10 MILE RD
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City | CENTER LINE
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State | MI
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Zip | 48015-1167
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Country | US
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Telephone | 586-619-9986
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Fax | 586-806-5085
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Authorized Official
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Title or Position | CEO
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Name | KAREN WOOD
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Credential |
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Telephone | 586-619-9986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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