Provider Demographics
NPI:1053301366
Name:SYSTECH INC
Entity Type:Organization
Organization Name:SYSTECH INC
Other - Org Name:CARE ORIGIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KANCHARLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-712-1100
Mailing Address - Street 1:30700 TELEGRAPH RD
Mailing Address - Street 2:SUITE # 4559
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4524
Mailing Address - Country:US
Mailing Address - Phone:248-712-1100
Mailing Address - Fax:248-479-5201
Practice Address - Street 1:30700 TELEGRAPH RD
Practice Address - Street 2:SUITE # 4559
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4524
Practice Address - Country:US
Practice Address - Phone:248-712-1100
Practice Address - Fax:248-479-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23-7545251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-7545Medicare ID - Type UnspecifiedHOME HEALTH CARE