Provider Demographics
NPI:1083856876
Name:UNIVERSAL HOMECARE PRIVATE DUTY, LLC
Entity Type:Organization
Organization Name:UNIVERSAL HOMECARE PRIVATE DUTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:EKONG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:810-742-4353
Mailing Address - Street 1:4199 DAVISON RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1468
Mailing Address - Country:US
Mailing Address - Phone:810-742-4353
Mailing Address - Fax:810-742-4355
Practice Address - Street 1:4199 DAVISON RD
Practice Address - Street 2:SUITE C
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1468
Practice Address - Country:US
Practice Address - Phone:810-742-4353
Practice Address - Fax:810-742-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care