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General NPI Number Information
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NPI Number | 1811941461
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Entity Type | Organization
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Legal Business Name | LIFE CARE AT HOME OF MICHIGAN INC
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 01/24/2013
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Provider Practice Location Address
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Address Line | 15450 NORTHLINE RD SUITE 102
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City | SOUTHGATE
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State | MI
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Zip | 48195-2398
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Country | US
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Telephone | 734-284-4315
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Fax | 734-284-6125
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Provider Business Mailing Address
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Address Line | 3001 KEITH ST NW
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City | CLEVELAND
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State | TN
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Zip | 37312-3713
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Country | US
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Telephone | 423-473-5280
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Fax | 423-339-8356
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Authorized Official
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Title or Position | VICE PRESIDENT FINANCE
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Name | PAM RAU
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Credential |
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Telephone | 423-473-5280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 001
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License Number State | MI
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