Provider Demographics
NPI:1326472457
Name:MANOR HOUSE PALLIATIVE AND HOSPICE CARE LLC
Entity Type:Organization
Organization Name:MANOR HOUSE PALLIATIVE AND HOSPICE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCLERKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:898-505-5916
Mailing Address - Street 1:21700 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 880
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4906
Mailing Address - Country:US
Mailing Address - Phone:888-505-5916
Mailing Address - Fax:313-450-4533
Practice Address - Street 1:21700 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 880
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4906
Practice Address - Country:US
Practice Address - Phone:888-505-5916
Practice Address - Fax:313-450-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based