Provider Demographics
NPI:1508759531
Name:SPECIAL CARE PROVIDER
Entity type:Organization
Organization Name:SPECIAL CARE PROVIDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HELP CARE
Authorized Official - Prefix:
Authorized Official - First Name:CATRECE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-283-2943
Mailing Address - Street 1:2211 S TELEGRAPH RD UNIT 7835
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-4833
Mailing Address - Country:US
Mailing Address - Phone:313-283-2943
Mailing Address - Fax:
Practice Address - Street 1:578 NEVADA AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-2553
Practice Address - Country:US
Practice Address - Phone:313-283-2943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care