Provider Demographics
NPI:1164194403
Name:SE MICHIGAN SENIOR SERVICES LLC
Entity Type:Organization
Organization Name:SE MICHIGAN SENIOR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED PERSONNEL
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-545-0707
Mailing Address - Street 1:6905 TELEGRAPH RD STE 360
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3189
Mailing Address - Country:US
Mailing Address - Phone:248-545-0707
Mailing Address - Fax:248-545-0270
Practice Address - Street 1:1915 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-1173
Practice Address - Country:US
Practice Address - Phone:248-335-7020
Practice Address - Fax:248-335-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332U00000XSuppliersHome Delivered MealsGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty