Provider Demographics
NPI:1851337604
Name:NORTHWOOD INC
Entity Type:Organization
Organization Name:NORTHWOOD INC
Other - Org Name:CARE CONNECTION PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FASSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-755-3830
Mailing Address - Street 1:25790 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-4157
Mailing Address - Country:US
Mailing Address - Phone:586-755-3830
Mailing Address - Fax:586-755-3733
Practice Address - Street 1:25790 COMMERCE DR STE 100
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-4157
Practice Address - Country:US
Practice Address - Phone:586-755-3830
Practice Address - Fax:586-755-3733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MI53010100583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139656OtherPK
MI4961470Medicaid