MEDICARE: WEST MICHIGAN IN HOME CARE

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	06534J	MI

General Provider Information

NPI Number	:	1831632819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST MICHIGAN IN HOME CARE

Provider Business Mailing Address
First Line	:	3658 CHICAGO DR STE 1
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-2602
Country	:	US
Telephone Number	:	616-780-9503
Fax Number	:	616-582-5974

Provider Business Practice Location Address
First Line	:	3658 CHICAGO DR STE 1
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-2602
Country	:	US
Telephone Number	:	616-780-9503
Fax Number	:	616-582-5974

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT DOSS
Credential	:	RRTS
Telephone Number	:	616-780-9503

Provider Enumeration Date	:	11/23/2016
Last Update Date	:	11/23/2016

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Directions to “WEST MICHIGAN IN HOME CARE ” Practice Location

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