Provider Demographics
NPI:1659452803
Name:EULICARE HOME HEALTH SERVICE, LLC
Entity Type:Organization
Organization Name:EULICARE HOME HEALTH SERVICE, LLC
Other - Org Name:EULICARE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KPAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-522-9399
Mailing Address - Street 1:PO BOX 35399
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-0399
Mailing Address - Country:US
Mailing Address - Phone:313-566-5356
Mailing Address - Fax:313-731-2008
Practice Address - Street 1:16213 W SEVEN MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-0399
Practice Address - Country:US
Practice Address - Phone:313-566-5356
Practice Address - Fax:313-731-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI87458204Medicaid
MI5071400001OtherMEDICARE PROVIDER
MI540H221350OtherBCBS PIN#
MI5071470001Medicare NSC