Provider Demographics
NPI:1447773593
Name:112 GROUP
Entity Type:Organization
Organization Name:112 GROUP
Other - Org Name:REAL TIME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MFON
Authorized Official - Middle Name:
Authorized Official - Last Name:UMANA-ODEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-239-0688
Mailing Address - Street 1:42211 GARFIELD RD STE 231
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1648
Mailing Address - Country:US
Mailing Address - Phone:586-239-0688
Mailing Address - Fax:586-239-0689
Practice Address - Street 1:45034 RIVERWOODS DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5780
Practice Address - Country:US
Practice Address - Phone:586-239-0688
Practice Address - Fax:586-239-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care