Provider Demographics
NPI:1821604315
Name:ESSENTIAL RELIABLE CARE LLC
Entity Type:Organization
Organization Name:ESSENTIAL RELIABLE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLIMPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-558-0454
Mailing Address - Street 1:480 N CANTON CENTER RD # 1523
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-8781
Mailing Address - Country:US
Mailing Address - Phone:248-558-0454
Mailing Address - Fax:
Practice Address - Street 1:513 CHERRY ORCHARD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-5272
Practice Address - Country:US
Practice Address - Phone:248-558-0454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-20
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8018659Medicaid