Provider Demographics
NPI:1013456300
Name:SPECIAL TREE HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:SPECIAL TREE HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-951-4041
Mailing Address - Street 1:39000 CHASE ST
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-1303
Mailing Address - Country:US
Mailing Address - Phone:248-951-4041
Mailing Address - Fax:734-893-3123
Practice Address - Street 1:39000 CHASE ST
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-1303
Practice Address - Country:US
Practice Address - Phone:248-951-4041
Practice Address - Fax:734-893-3123
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIAL TREE, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health