Provider Demographics
NPI:1780686980
Name:HOMCARE INC.
Entity Type:Organization
Organization Name:HOMCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O. /TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:231-755-6951
Mailing Address - Street 1:875 W SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4047
Mailing Address - Country:US
Mailing Address - Phone:231-755-6951
Mailing Address - Fax:231-755-4507
Practice Address - Street 1:875 W SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-4047
Practice Address - Country:US
Practice Address - Phone:231-755-6951
Practice Address - Fax:231-755-4507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2730885251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2730885Medicaid
MI237224Medicare ID - Type UnspecifiedHOME HEALTH PROVIDER