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General NPI Number Information
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NPI Number | 1780076059
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Entity Type | Individual
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Provider Name | MARY JAN CARTER
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Gender | Female
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Dates
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Enumeration Date | 02/24/2015
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Last Update Date | 02/24/2015
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Provider Practice Location Address
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Address Line | 17570 S RIVER RD
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City | THREE RIVERS
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State | MI
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Zip | 49093-9323
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Country | US
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Telephone | 708-600-5845
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Fax |
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Provider Business Mailing Address
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Address Line | 17570 S RIVER RD
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City | THREE RIVERS
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State | MI
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Zip | 49093-9323
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Country | US
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Telephone | 269-873-0399
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 251E00000X
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License Number State | MI
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | 472761843
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License Number State | MI
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