Provider Demographics
NPI:1396025607
Name:MICHIGAN PREMIER HOME CARE AND HOSPICE LLC
Entity Type:Organization
Organization Name:MICHIGAN PREMIER HOME CARE AND HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JABEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUKHARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-345-0033
Mailing Address - Street 1:312 E HOUGHTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-1188
Mailing Address - Country:US
Mailing Address - Phone:989-345-0033
Mailing Address - Fax:989-345-0055
Practice Address - Street 1:312 E HOUGHTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1188
Practice Address - Country:US
Practice Address - Phone:989-345-0033
Practice Address - Fax:989-345-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
239276Medicare Oscar/Certification