Provider Demographics
NPI:1386029197
Name:SAMUELSON ASSOCIATES
Entity Type:Organization
Organization Name:SAMUELSON ASSOCIATES
Other - Org Name:GRACE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENSON
Authorized Official - Middle Name:VARGHESE
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-420-9990
Mailing Address - Street 1:138 RIDGE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1988
Mailing Address - Country:US
Mailing Address - Phone:571-420-9990
Mailing Address - Fax:
Practice Address - Street 1:138 RIDGE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1988
Practice Address - Country:US
Practice Address - Phone:571-420-9990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 251F00000X, 251J00000X, 251K00000X, 253Z00000X
MI3879399251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare
No253Z00000XAgenciesIn Home Supportive Care