Provider Demographics
NPI:1093565590
Name:RESIDECARE LLC
Entity Type:Organization
Organization Name:RESIDECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CATHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-767-6851
Mailing Address - Street 1:PO BOX 970235
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-0031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:269-666-6098
Practice Address - Street 1:1161 NASH AVE
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-6291
Practice Address - Country:US
Practice Address - Phone:734-460-2558
Practice Address - Fax:734-533-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities