Organization
TRAVERSE CITY RESIDENTIA LCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HELENA (SAM KAY EVANS CAREGIVER (OWNER OF AGENCY/MANAGER/BILLING)
(231) 313-9633
Entity
Organization
Contact information
Practice address
176 ISLAND VIEW DR, TRAVERSE CITY, MI 49696-9313
(231) 313-9633
Mailing address
176 ISLAND VIEW DR, TRAVERSE CITY, MI 49696-9313
(231) 313-9633
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
9674527
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9674527
—
MI
Enumeration date
01/08/2014
Last updated
01/08/2014
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