Provider Demographics
NPI:1528001823
Name:PROVISION HOME CARE LLC
Entity Type:Organization
Organization Name:PROVISION HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:MY
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-852-4100
Mailing Address - Street 1:2888 E LONG LAKE RD STE 127
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3793
Mailing Address - Country:US
Mailing Address - Phone:247-852-1700
Mailing Address - Fax:248-852-4802
Practice Address - Street 1:2888 E LONG LAKE RD STE 127
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-3793
Practice Address - Country:US
Practice Address - Phone:247-852-1700
Practice Address - Fax:248-852-4802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1528001823OtherBCBS