Organization
RESIDENTIAL HOME HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFF MICHEAL MASTIN (ADMINISTRATIVE ASSISTANT)
(586) 751-0200
Entity
Organization
Contact information
Practice address
11477 E 12 MILE RD, WARREN, MI 48093-2678
(586) 751-0200
(586) 751-0414
Mailing address
11477 E 12 MILE RD, WARREN, MI 48093-2678
(586) 751-0200
(586) 751-0414
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
5901000447
MI
261QP1100X
Podiatric Clinic/Center
5901000468
MI
261QP1100X
Podiatric Clinic/Center
5901001570
MI
261QP2300X
Primary Care Clinic/Center
4301025138
MI
261QP2300X
Primary Care Clinic/Center
4301046450
MI
261QP2300X
Primary Care Clinic/Center
4301095717
MI
261QP2300X
Primary Care Clinic/Center
Primary
5101006690
MI
Other
Enumeration date
11/06/2014
Last updated
11/06/2014
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