Provider Demographics
NPI:1326272840
Name:HEALING HANDS HOME PHYSICIAN SERVICES
Entity Type:Organization
Organization Name:HEALING HANDS HOME PHYSICIAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KNAFEL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:269-924-6978
Mailing Address - Street 1:309 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1524
Mailing Address - Country:US
Mailing Address - Phone:269-924-6978
Mailing Address - Fax:734-448-4008
Practice Address - Street 1:309 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1524
Practice Address - Country:US
Practice Address - Phone:269-924-6978
Practice Address - Fax:734-448-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001850363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI.R54366Medicare UPIN