Organization
WORCESTER HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARYLIN BROWN (VICE PRESIDENT)
(248) 996-0604
Entity
Organization
Contact information
Practice address
24922 INDEPENDENCE DR APT 6208, FARMINGTON HILLS, MI 48335-1744
(248) 996-0604
Mailing address
24922 INDEPENDENCE DR APT 6208, FARMINGTON HILLS, MI 48335-1744
(248) 996-0604
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
716877
MI
305R00000X
Preferred Provider Organization
716877
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
716877
—
MI
Enumeration date
12/04/2009
Last updated
12/23/2009
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