Provider Demographics
NPI:1912040098
Name:ACCREDITED HOME CARE, INC.
Entity Type:Organization
Organization Name:ACCREDITED HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-923-2361
Mailing Address - Street 1:27733 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6641
Mailing Address - Country:US
Mailing Address - Phone:586-427-6640
Mailing Address - Fax:586-427-6642
Practice Address - Street 1:27733 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6641
Practice Address - Country:US
Practice Address - Phone:586-427-6640
Practice Address - Fax:586-427-6642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001469251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237468Medicare ID - Type Unspecified