Provider Demographics
NPI:1871852533
Name:PRIMARY CARE HOME SERVICES, INC
Entity Type:Organization
Organization Name:PRIMARY CARE HOME SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUDY-EGGER
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:313-870-9260
Mailing Address - Street 1:2990 W GRAND BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3041
Mailing Address - Country:US
Mailing Address - Phone:313-870-9260
Mailing Address - Fax:313-870-9266
Practice Address - Street 1:2990 W GRAND BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3041
Practice Address - Country:US
Practice Address - Phone:313-870-9260
Practice Address - Fax:313-870-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty