MEDICARE: REDICARE HEALTHCARE SERVICES

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1659606317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDICARE HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	17800 E WARREN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-1332
Country	:	US
Telephone Number	:	313-343-5301
Fax Number	:	313-343-6653

Provider Business Practice Location Address
First Line	:	17800 E WARREN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-1332
Country	:	US
Telephone Number	:	313-343-5301
Fax Number	:	313-343-6653

Authorized Official
Title or Position	:	ADMINISTRATION
Name	:	MS. JERCENTIA M LUDY
Credential	:	CASEMANAGEMENT
Telephone Number	:	313-343-5301

Provider Enumeration Date	:	10/13/2009
Last Update Date	:	10/13/2009

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