# INDEPENDENT HOME CARE OF MICHIGAN LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194965343
- **Authorized official:** MS. MARY KATHRYN CLARK RN CCM (OWNER)
- **Authorized official phone:** (810) 750-2713

## Contact information

- **Practice address:** 13280 OLD OAKS DR, FENTON, MI 48430-9497
- **Practice address phone:** (810) 750-2713
- **Practice address fax:** (810) 714-2386
- **Mailing address:** 13280 OLD OAKS DR, FENTON, MI 48430-9497
- **Mailing address phone:** (810) 750-2713
- **Mailing address fax:** (810) 714-2386

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | MI | — |
| 251E00000X | Home Health Agency | — | MI | Yes |

## Other

- **Enumeration date:** 03/01/2009
- **Last updated:** 03/01/2009