Provider Demographics
NPI:1922110519
Name:PRIORITY HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:PRIORITY HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:586-979-2267
Mailing Address - Street 1:11455 E 13 MILE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2502
Mailing Address - Country:US
Mailing Address - Phone:586-979-2267
Mailing Address - Fax:586-979-1185
Practice Address - Street 1:11455 E 13 MILE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2502
Practice Address - Country:US
Practice Address - Phone:586-979-2267
Practice Address - Fax:586-979-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI119222OtherGREAT LAKES HEALTH PLAN
MI61308OtherOMNI CARE
MI3288397OtherMOLINA HEALTHCARE OF MICH
MI000000003584OtherCAPE MEDICAL HMO
MI008524OtherMIDWEST HEALTH PLAN
MI21256OtherHEALTH PLAN OF MICHIGAN
MI21256OtherHEALTH PLAN OF MICHIGAN