MEDICARE: ALTUM CARE HOMES

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	313M00000X	Nursing Facility/Intermediate Care Facility	AS630332450	MI
2	385H00000X	Respite Care	AS630332450	MI
3	311Z00000X	Custodial Care Facility	AS630332450	MI

General Provider Information

NPI Number	:	1528491438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTUM CARE HOMES

Provider Business Mailing Address
First Line	:	23408 PLUM HOLLOW ST
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3275
Country	:	US
Telephone Number	:	248-809-6202
Fax Number	:

Provider Business Practice Location Address
First Line	:	23408 PLUM HOLLOW ST
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3275
Country	:	US
Telephone Number	:	248-809-6202
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RONDA FREEMAN
Credential	:
Telephone Number	:	313-377-3776

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	08/14/2013

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