Provider Demographics
NPI:1720401458
Name:SOUTHEASTERN MICHIGAN HOMECARE SOLUTIONS, INC
Entity Type:Organization
Organization Name:SOUTHEASTERN MICHIGAN HOMECARE SOLUTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-794-9036
Mailing Address - Street 1:102 KERCHEVAL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3660
Mailing Address - Country:US
Mailing Address - Phone:313-794-9036
Mailing Address - Fax:313-794-9039
Practice Address - Street 1:102 KERCHEVAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3660
Practice Address - Country:US
Practice Address - Phone:313-794-9036
Practice Address - Fax:313-794-9039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI03318QOtherSTATE OF MICHIGAN