Provider Demographics
NPI:1790148641
Name:CGM HOME HEALTHCARE SERVICES, INC
Entity Type:Organization
Organization Name:CGM HOME HEALTHCARE SERVICES, INC
Other - Org Name:CGM HOME HEALTHCARE AND ANESTHESIA SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:FELIX
Authorized Official - Last Name:NYAMBIO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:313-270-7751
Mailing Address - Street 1:17356 W 12 MILE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-6316
Mailing Address - Country:US
Mailing Address - Phone:313-270-7751
Mailing Address - Fax:313-270-7291
Practice Address - Street 1:17356 W 12 MILE RD STE 202
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-6316
Practice Address - Country:US
Practice Address - Phone:313-270-7751
Practice Address - Fax:313-270-7291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704256997251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1902234040Medicaid