Provider Demographics
NPI:1972536290
Name:SPARROW COMMUNITY CARE
Entity Type:Organization
Organization Name:SPARROW COMMUNITY CARE
Other - Org Name:UNIVERSITY OF MICHIGAN HEALTH-SPARROW HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR, PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:GUNTER
Authorized Official - Last Name:RUSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-253-6308
Mailing Address - Street 1:8175 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0081
Mailing Address - Country:US
Mailing Address - Phone:517-364-8600
Mailing Address - Fax:517-364-8620
Practice Address - Street 1:2909 E GRAND RIVER AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4300
Practice Address - Country:US
Practice Address - Phone:517-364-8600
Practice Address - Fax:517-364-8620
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPARROW HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-09
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI15-1635264Medicaid
MI72-70004OtherPHYSICIANS HEALTH PLAN FC
MI60-00004OtherPHYSICIANS HEALTH PLAN MM
MI72-70004OtherPHYSICIANS HEALTH PLAN FC