Provider Demographics
NPI:1952305906
Name:MAXICARE HOME HEALTH AGENCY, INC
Entity Type:Organization
Organization Name:MAXICARE HOME HEALTH AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:TCRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-293-1600
Mailing Address - Street 1:28909 UTICA ROAD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066
Mailing Address - Country:US
Mailing Address - Phone:586-293-1600
Mailing Address - Fax:586-293-1617
Practice Address - Street 1:28909 UTICA ROAD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066
Practice Address - Country:US
Practice Address - Phone:586-293-1600
Practice Address - Fax:586-293-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIN/A251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI154376433Medicaid
MI0E928OtherBCBS
237467Medicare ID - Type Unspecified