Provider Demographics
NPI:1205506862
Name:CARELINE PIN100 LLC
Entity type:Organization
Organization Name:CARELINE PIN100 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-888-4000
Mailing Address - Street 1:103 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2211
Mailing Address - Country:US
Mailing Address - Phone:517-212-2006
Mailing Address - Fax:
Practice Address - Street 1:600 E CARMEL DR STE 144
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3053
Practice Address - Country:US
Practice Address - Phone:517-212-2008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty