=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831632819
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST MICHIGAN IN HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2016
-----------------------------------------------------
Last Update Date | 11/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3658 CHICAGO DR STE 1
-----------------------------------------------------
City | HUDSONVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49426-2602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-780-9503
-----------------------------------------------------
Fax | 616-582-5974
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3658 CHICAGO DR STE 1
-----------------------------------------------------
City | HUDSONVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49426-2602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-780-9503
-----------------------------------------------------
Fax | 616-582-5974
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROBERT DOSS
-----------------------------------------------------
Credential | RRTS
-----------------------------------------------------
Telephone | 616-780-9503
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 06534J
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------