Provider Demographics
NPI:1578991311
Name:INDEPENDENT HOME CARE OF MI, LLC
Entity Type:Organization
Organization Name:INDEPENDENT HOME CARE OF MI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:TRILBY
Authorized Official - Last Name:FLICK
Authorized Official - Suffix:
Authorized Official - Credentials:BBA/MBA
Authorized Official - Phone:810-750-2713
Mailing Address - Street 1:14165 N FENTON RD STE 102B
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1148
Mailing Address - Country:US
Mailing Address - Phone:810-750-2713
Mailing Address - Fax:810-750-1261
Practice Address - Street 1:14165 N FENTON RD STE 102B
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1148
Practice Address - Country:US
Practice Address - Phone:810-750-2713
Practice Address - Fax:810-750-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child