Provider Demographics
NPI:1043533672
Name:TOTALLY EXCELLENT CARE, INC.
Entity Type:Organization
Organization Name:TOTALLY EXCELLENT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-587-9801
Mailing Address - Street 1:29498 ASHLAND AVE
Mailing Address - Street 2:106
Mailing Address - City:HARRISON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-2287
Mailing Address - Country:US
Mailing Address - Phone:313-587-9801
Mailing Address - Fax:313-839-2007
Practice Address - Street 1:29498 ASHLAND AVE
Practice Address - Street 2:106
Practice Address - City:HARRISON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48045-2287
Practice Address - Country:US
Practice Address - Phone:313-587-9801
Practice Address - Fax:313-839-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0009446Medicaid