Provider Demographics
NPI:1952334187
Name:OLDER ADULT HOME CARE SERVICES, INC.
Entity Type:Organization
Organization Name:OLDER ADULT HOME CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMINISTRATOR/DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:313-980-0175
Mailing Address - Street 1:10882 BEECH DALY RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3144
Mailing Address - Country:US
Mailing Address - Phone:313-291-2782
Mailing Address - Fax:313-291-4056
Practice Address - Street 1:10882 BEECH DALY RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3144
Practice Address - Country:US
Practice Address - Phone:313-291-2782
Practice Address - Fax:313-291-4056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237534Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER