Provider Demographics
NPI:1003026709
Name:HEALTHSOURCE INC
Entity Type:Organization
Organization Name:HEALTHSOURCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF CLAIMS AND TECHNOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:SABAH
Authorized Official - Middle Name:
Authorized Official - Last Name:VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-966-8467
Mailing Address - Street 1:PO BOX 44290
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48244-0290
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4707 SAINT ANTOINE ST
Practice Address - Street 2:SUITE G20
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1427
Practice Address - Country:US
Practice Address - Phone:800-543-0161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization