Provider Demographics
NPI:1740751346
Name:CARE RESOURCE TEAM
Entity Type:Organization
Organization Name:CARE RESOURCE TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRI
Authorized Official - Middle Name:D
Authorized Official - Last Name:MEDVED
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-421-7633
Mailing Address - Street 1:1327 SHERWOOD FOREST CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1677
Mailing Address - Country:US
Mailing Address - Phone:248-421-7633
Mailing Address - Fax:
Practice Address - Street 1:5758 COOLEY LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-3073
Practice Address - Country:US
Practice Address - Phone:248-421-7633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-08
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1376593228Medicaid