Provider Demographics
NPI:1437182714
Name:FRESH PERSPECTIVE HOME CARE LLC
Entity Type:Organization
Organization Name:FRESH PERSPECTIVE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-330-2397
Mailing Address - Street 1:31785 PAWTON LN
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079
Mailing Address - Country:US
Mailing Address - Phone:269-329-4717
Mailing Address - Fax:269-329-4716
Practice Address - Street 1:7127 S. WESTNEDGE AVE
Practice Address - Street 2:STE #5A
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002
Practice Address - Country:US
Practice Address - Phone:269-329-4717
Practice Address - Fax:269-329-4716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7199523Medicaid