Provider Demographics
NPI:1801233465
Name:WELLNESS GROUP HOME CARE LLC
Entity Type:Organization
Organization Name:WELLNESS GROUP HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-247-6717
Mailing Address - Street 1:2609 CROOKS RD STE 242
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:248-247-6717
Mailing Address - Fax:248-247-6220
Practice Address - Street 1:26300 FORD RD STE 421
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2854
Practice Address - Country:US
Practice Address - Phone:313-355-7886
Practice Address - Fax:313-427-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility