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General NPI Number Information
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NPI Number | 1851991699
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Entity Type | Organization
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Legal Business Name | CACCK ENTERPRISE INC
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Dates
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Enumeration Date | 10/30/2020
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 15851 S US 27 STE 314
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City | LANSING
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State | MI
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Zip | 48906-1987
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Country | US
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Telephone | 517-332-9953
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Fax |
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Provider Business Mailing Address
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Address Line | 5859 W SAGINAW HWY STE 175
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City | LANSING
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State | MI
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Zip | 48917-2460
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Country | US
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Telephone | 517-332-9953
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMY KANOUSE
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Credential |
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Telephone | 517-332-9953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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