MEDICARE: PLATINUM PLUS CARE 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1720520679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLATINUM PLUS CARE SERVICES

Provider Business Mailing Address
First Line	:	6722 WHISPERING WOODS DR
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-5204
Country	:	US
Telephone Number	:	248-470-5285
Fax Number	:

Provider Business Practice Location Address
First Line	:	6722 WHISPERING WOODS DR
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-5204
Country	:	US
Telephone Number	:	248-470-5285
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CLINTON POWELL
Credential	:
Telephone Number	:	248-470-5285

Provider Enumeration Date	:	11/09/2016
Last Update Date	:	11/09/2016

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