Provider Demographics
NPI:1992823967
Name:CHS OF GREATER DETROIT,LLC
Entity Type:Organization
Organization Name:CHS OF GREATER DETROIT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN PHD
Authorized Official - Phone:313-341-8810
Mailing Address - Street 1:19830 JAMES COUZENS FWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1938
Mailing Address - Country:US
Mailing Address - Phone:313-341-8810
Mailing Address - Fax:313-341-8820
Practice Address - Street 1:19830 JAMES COUZENS FWY
Practice Address - Street 2:SUITE A
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1938
Practice Address - Country:US
Practice Address - Phone:313-341-8810
Practice Address - Fax:313-341-8820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
237717Medicare Oscar/Certification