Provider Demographics
NPI:1689136210
Name:PROMOTING INDEPENDENT LIVING CONCIERGE
Entity Type:Organization
Organization Name:PROMOTING INDEPENDENT LIVING CONCIERGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLETTA
Authorized Official - Middle Name:EEDSEL
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:810-814-6628
Mailing Address - Street 1:3079 S BALDWIN RD STE 1050
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1028
Mailing Address - Country:US
Mailing Address - Phone:248-636-2192
Mailing Address - Fax:
Practice Address - Street 1:3079 S BALDWIN RD STE 1050
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1028
Practice Address - Country:US
Practice Address - Phone:248-636-2192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health