Provider Demographics
NPI:1114393253
Name:UNIQUE IN HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:UNIQUE IN HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHALVONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-315-0151
Mailing Address - Street 1:PO BOX 40151
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-0151
Mailing Address - Country:US
Mailing Address - Phone:313-466-4091
Mailing Address - Fax:313-740-7458
Practice Address - Street 1:19964 ROGGE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3031
Practice Address - Country:US
Practice Address - Phone:313-466-4091
Practice Address - Fax:313-543-3172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7809391Medicaid