Provider Demographics
NPI:1164520086
Name:CARE SOURCE, INC
Entity Type:Organization
Organization Name:CARE SOURCE, INC
Other - Org Name:METRON HEALTH CARE PRODUCTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GM
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-957-1490
Mailing Address - Street 1:96 S SEAWAY DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3841
Mailing Address - Country:US
Mailing Address - Phone:231-739-3436
Mailing Address - Fax:231-739-3367
Practice Address - Street 1:96 S SEAWAY DR
Practice Address - Street 2:
Practice Address - City:MUSKEGON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:49444-3841
Practice Address - Country:US
Practice Address - Phone:231-739-3436
Practice Address - Fax:231-739-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883950Medicaid
MI1883950Medicaid