Provider Demographics
NPI:1447432794
Name:LIVONIA PALLIATIVE CARE P.L.L.C.
Entity Type:Organization
Organization Name:LIVONIA PALLIATIVE CARE P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BOAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-953-6033
Mailing Address - Street 1:14100 NEWBURGH RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5010
Mailing Address - Country:US
Mailing Address - Phone:724-953-6033
Mailing Address - Fax:
Practice Address - Street 1:14100 NEWBURGH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5010
Practice Address - Country:US
Practice Address - Phone:724-953-6033
Practice Address - Fax:734-464-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070040207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P51870Medicare PIN
H61819Medicare UPIN