Provider Demographics
NPI:1407201585
Name:MICHIGAN INFANT CARE, LLC
Entity Type:Organization
Organization Name:MICHIGAN INFANT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-439-8697
Mailing Address - Street 1:28807 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-2590
Mailing Address - Country:US
Mailing Address - Phone:586-439-8697
Mailing Address - Fax:
Practice Address - Street 1:28807 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-2590
Practice Address - Country:US
Practice Address - Phone:586-439-8697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management