Provider Demographics
NPI:1245342310
Name:CARE ORIGIN INC.,
Entity type:Organization
Organization Name:CARE ORIGIN INC.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KANCHARLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-712-1100
Mailing Address - Street 1:30700 TELEGRAPH RD
Mailing Address - Street 2:SUITE 4559
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4524
Mailing Address - Country:US
Mailing Address - Phone:248-712-0022
Mailing Address - Fax:248-712-0930
Practice Address - Street 1:30700 TELEGRAPH RD
Practice Address - Street 2:SUITE 4559
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4524
Practice Address - Country:US
Practice Address - Phone:248-712-0022
Practice Address - Fax:248-712-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-7545Medicare ID - Type Unspecified