Provider Demographics
NPI:1265250351
Name:MONTGOMERY FAMILY CARE LLC
Entity type:Organization
Organization Name:MONTGOMERY FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-919-8333
Mailing Address - Street 1:43313 WOODWARD AVE # 1451
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5007
Mailing Address - Country:US
Mailing Address - Phone:248-919-8388
Mailing Address - Fax:
Practice Address - Street 1:2785 E GRAND BLVD UNIT 169
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48211-2003
Practice Address - Country:US
Practice Address - Phone:248-919-8388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-28
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care