Provider Demographics
NPI:1508982927
Name:MUNSON HOME CARE
Entity Type:Organization
Organization Name:MUNSON HOME CARE
Other - Org Name:MUNSON HOSPICE AND PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-935-8432
Mailing Address - Street 1:1105 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2345
Mailing Address - Country:US
Mailing Address - Phone:231-935-6520
Mailing Address - Fax:231-935-9116
Practice Address - Street 1:550 MUNSON AVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3580
Practice Address - Country:US
Practice Address - Phone:231-935-6420
Practice Address - Fax:866-380-0564
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNSON HOME HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-21
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4217384Medicaid
MI08779OtherMI BCBS
MI0P24420Medicare ID - Type UnspecifiedWPS PALLIATIVE CARE
MI231515Medicare ID - Type UnspecifiedUGS