=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760478986
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PASSPORT HOMECARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2005
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2611 WOODCREEK LN
-----------------------------------------------------
City | DAVISBURG
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48350-2140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-343-6985
-----------------------------------------------------
Fax | 248-328-8065
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2611 WOODCREEK LN
-----------------------------------------------------
City | DAVISBURG
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48350-2140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-343-6985
-----------------------------------------------------
Fax | 248-328-8065
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING / ADMINISTRATIVE MANAGER
-----------------------------------------------------
Name | MRS. REBECCA E COMSTOCK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-343-6985
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------