Provider Demographics
NPI:1558069823
Name:IMPERIUM HOME CARE,LLC
Entity Type:Organization
Organization Name:IMPERIUM HOME CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO & CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-202-2781
Mailing Address - Street 1:337 E HURON ST
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1429
Mailing Address - Country:US
Mailing Address - Phone:989-202-2781
Mailing Address - Fax:
Practice Address - Street 1:1960 W HOUGHTON LAKE DR STE 4
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629-9297
Practice Address - Country:US
Practice Address - Phone:989-202-2789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health