Provider Demographics
NPI:1043203383
Name:MDM HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:MDM HOME HEALTH CARE, INC.
Other - Org Name:FAMILY HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-414-9990
Mailing Address - Street 1:801 W ANN ARBOR TRL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1694
Mailing Address - Country:US
Mailing Address - Phone:734-414-9990
Mailing Address - Fax:734-414-9200
Practice Address - Street 1:9150 E 109TH AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7687
Practice Address - Country:US
Practice Address - Phone:219-310-8537
Practice Address - Fax:219-779-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10-009481-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
157469Medicare Oscar/Certification