Provider Demographics
NPI:1093599672
Name:MARSHALL'S PREMIER CARE
Entity Type:Organization
Organization Name:MARSHALL'S PREMIER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTENA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-676-8337
Mailing Address - Street 1:19724 MOROSS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1170
Mailing Address - Country:US
Mailing Address - Phone:586-676-8337
Mailing Address - Fax:
Practice Address - Street 1:19724 MOROSS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1170
Practice Address - Country:US
Practice Address - Phone:586-676-8337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization