Provider Demographics
NPI:1164961090
Name:CONTINUITY CASE MANAGEMENT SERVICES
Entity Type:Organization
Organization Name:CONTINUITY CASE MANAGEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROFESSIONAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:SUPRENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-550-6629
Mailing Address - Street 1:20615 FENKELL ST
Mailing Address - Street 2:231052
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-3778
Mailing Address - Country:US
Mailing Address - Phone:866-550-6629
Mailing Address - Fax:248-607-6756
Practice Address - Street 1:24801 5 MILE RD
Practice Address - Street 2:12
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3655
Practice Address - Country:US
Practice Address - Phone:866-550-6629
Practice Address - Fax:248-607-6757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-12
Last Update Date:2017-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI163WHO200XOtherHOME CARE