MEDICARE: COORDINATED CARE 1, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	251B00000X	Case Management Agency
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	343900000X	Non-emergency Medical Transport (VAN)
5	372600000X	Adult Companion

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05438U	OTHER	MI	PRIVATE PAY

General Provider Information

NPI Number	:	1174025415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COORDINATED CARE 1, INC

Provider Business Mailing Address
First Line	:	PO BOX 99705
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48099-9705
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2328 E 7 MILE RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-1304
Country	:	US
Telephone Number	:	248-443-8044
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	GIGI J
Credential	:
Telephone Number	:	248-443-8044

Provider Enumeration Date	:	03/02/2018
Last Update Date	:	12/14/2020

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