Provider Demographics
NPI:1073680799
Name:SPECIALIZED HOMECARE INC
Entity Type:Organization
Organization Name:SPECIALIZED HOMECARE INC
Other - Org Name:ADVENT HOME MEDICAL, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CICHON
Authorized Official - Suffix:
Authorized Official - Credentials:RRT BS
Authorized Official - Phone:877-944-9800
Mailing Address - Street 1:1535 HIGHWOOD E
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-1234
Mailing Address - Country:US
Mailing Address - Phone:877-944-9800
Mailing Address - Fax:248-409-0403
Practice Address - Street 1:1535 HIGHWOOD E
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-1234
Practice Address - Country:US
Practice Address - Phone:877-944-9800
Practice Address - Fax:248-409-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4667092Medicaid
MI5179500001Medicare NSC