MEDICARE: WORCESTER HOME

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	305R00000X	Preferred Provider Organization	716877	MI
2	302R00000X	Health Maintenance Organization	716877	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861720609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WORCESTER HOME

Provider Business Mailing Address
First Line	:	24922 INDEPENDENCE DR APT 6208
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-1744
Country	:	US
Telephone Number	:	248-996-0604
Fax Number	:

Provider Business Practice Location Address
First Line	:	24922 INDEPENDENCE DR APT 6208
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-1744
Country	:	US
Telephone Number	:	248-996-0604
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MS. MARYLIN BROWN
Credential	:
Telephone Number	:	248-996-0604

Provider Enumeration Date	:	12/04/2009
Last Update Date	:	12/23/2009

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Directions to “WORCESTER HOME ” Practice Location

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