MEDICARE: RICHEY CARE CONSULTANTS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1184398067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHEY CARE CONSULTANTS LLC

Provider Business Mailing Address
First Line	:	15565 NORTHLAND DR W STE 505
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-5307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15565 NORTHLAND DR W STE 505
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-5307
Country	:	US
Telephone Number	:	248-797-9166
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	LIZ BECHARD
Credential	:
Telephone Number	:	248-797-9166

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	10/18/2021

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