Provider Demographics
NPI:1821196742
Name:CARE SOURCE, INC.
Entity Type:Organization
Organization Name:CARE SOURCE, INC.
Other - Org Name:METRON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GM
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-957-1490
Mailing Address - Street 1:8232 GRAPHIC DR NE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49306-9448
Mailing Address - Country:US
Mailing Address - Phone:616-866-0044
Mailing Address - Fax:616-866-9684
Practice Address - Street 1:8232 GRAPHIC DR NE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MI
Practice Address - Zip Code:49306-9448
Practice Address - Country:US
Practice Address - Phone:616-866-0044
Practice Address - Fax:616-866-9684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883950Medicaid