Provider Demographics
NPI:1013768472
Name:TRIBUTARY CORPORATION
Entity Type:Organization
Organization Name:TRIBUTARY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-807-0026
Mailing Address - Street 1:11205 MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-9155
Mailing Address - Country:US
Mailing Address - Phone:248-807-0026
Mailing Address - Fax:248-973-1864
Practice Address - Street 1:11205 MILFORD RD
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-9155
Practice Address - Country:US
Practice Address - Phone:248-807-0026
Practice Address - Fax:248-973-1864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health