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General NPI Number Information
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NPI Number | 1780782607
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Entity Type | Organization
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Legal Business Name | CARE SOURCE, INC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2605 S CLEVELAND AVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-3001
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Country | US
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Telephone | 269-429-5900
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Fax | 269-429-0092
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Provider Business Mailing Address
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Address Line | 2605 S CLEVELAND AVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-3001
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Country | US
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Telephone | 269-429-5900
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Fax | 269-429-0092
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARK A PIERSMA
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Credential |
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Telephone | 616-957-3957
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State | MI
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