Provider Demographics
NPI:1578886057
Name:YOUR COMMUNITY ABOVE AND BEYOND HOME HEALTH CARE
Entity Type:Organization
Organization Name:YOUR COMMUNITY ABOVE AND BEYOND HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:CHISHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-808-2797
Mailing Address - Street 1:PO BOX 1555
Mailing Address - Street 2:
Mailing Address - City:KALKASKA
Mailing Address - State:MI
Mailing Address - Zip Code:49646-1555
Mailing Address - Country:US
Mailing Address - Phone:866-808-2797
Mailing Address - Fax:231-258-4813
Practice Address - Street 1:303 CEDAR STREET
Practice Address - Street 2:
Practice Address - City:KALKASKA
Practice Address - State:MI
Practice Address - Zip Code:49646
Practice Address - Country:US
Practice Address - Phone:866-808-2797
Practice Address - Fax:231-258-4813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4607540Medicaid