Provider Demographics
NPI:1578845095
Name:COMFORTER CARE AGENCY
Entity Type:Organization
Organization Name:COMFORTER CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THEOPHILUS
Authorized Official - Middle Name:
Authorized Official - Last Name:EBOSI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA HEALTHCARE MAGT
Authorized Official - Phone:517-974-9012
Mailing Address - Street 1:4830 MALPASO
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1554
Mailing Address - Country:US
Mailing Address - Phone:517-974-9012
Mailing Address - Fax:517-886-5194
Practice Address - Street 1:4830 MALPASO
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1554
Practice Address - Country:US
Practice Address - Phone:517-974-9012
Practice Address - Fax:517-886-5194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-10
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No253J00000XAgenciesFoster Care Agency
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMSAMedicaid