Provider Demographics
NPI:1396597886
Name:CONSOLATE CARE LLC
Entity type:Organization
Organization Name:CONSOLATE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:248-242-2766
Mailing Address - Street 1:9961 ROBSON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-2416
Mailing Address - Country:US
Mailing Address - Phone:248-242-2766
Mailing Address - Fax:
Practice Address - Street 1:12411 E 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-2154
Practice Address - Country:US
Practice Address - Phone:248-272-2766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center