Provider Demographics
NPI:1245464668
Name:ARBOR WOODS HOME HEALTH CARE, INC.
Entity type:Organization
Organization Name:ARBOR WOODS HOME HEALTH CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NADEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-888-2333
Mailing Address - Street 1:1615 W CENTRE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5382
Mailing Address - Country:US
Mailing Address - Phone:269-888-2333
Mailing Address - Fax:269-888-2555
Practice Address - Street 1:1615 W CENTRE AVE STE 201
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024
Practice Address - Country:US
Practice Address - Phone:269-888-2333
Practice Address - Fax:269-888-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI239161Medicare Oscar/Certification