Provider Demographics
NPI:1164093126
Name:EXECUTIVE CASE MANAGEMENT LLC
Entity Type:Organization
Organization Name:EXECUTIVE CASE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:248-408-0632
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:UNION LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48387-0785
Mailing Address - Country:US
Mailing Address - Phone:248-408-0632
Mailing Address - Fax:
Practice Address - Street 1:2203 SHEARWATER CIR
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-4254
Practice Address - Country:US
Practice Address - Phone:248-408-0632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management