Organization
CARE RESOURCE TEAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRI D MEDVED RN (OWNER)
(248) 421-7633
Entity
Organization
Contact information
Practice address
5758 COOLEY LAKE RD, WATERFORD, MI 48327-3073
(248) 421-7633
Mailing address
1327 SHERWOOD FOREST CT, WATERFORD, MI 48327-1677
(248) 421-7633
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
—
—
251B00000X
Case Management Agency
—
—
251J00000X
Nursing Care Agency
—
—
261QP2300X
Primary Care Clinic/Center
—
—
305R00000X
Preferred Provider Organization
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376593228
—
MI
Enumeration date
12/08/2018
Last updated
01/15/2019
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