Provider Demographics
NPI:1447592449
Name:ST.MICHAEL INSPIRATIONAL CARE LLC
Entity Type:Organization
Organization Name:ST.MICHAEL INSPIRATIONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FRUNWI
Authorized Official - Last Name:ATIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-215-6791
Mailing Address - Street 1:3208 ROESCH BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-7000
Mailing Address - Country:US
Mailing Address - Phone:862-215-6791
Mailing Address - Fax:
Practice Address - Street 1:3208 ROESCH BLVD APT 4
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-7000
Practice Address - Country:US
Practice Address - Phone:862-215-6791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 251E00000X, 251J00000X, 251S00000X, 253J00000X, 311ZA0620X, 320900000X, 332B00000X, 347C00000X, 385HR2065X
OH0903419253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child