Provider Demographics
NPI:1639918824
Name:MOMENTUM CARE
Entity type:Organization
Organization Name:MOMENTUM CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LIMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOULAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-330-4527
Mailing Address - Street 1:40315 MICHIGAN AVE # 1048
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2908
Mailing Address - Country:US
Mailing Address - Phone:734-330-4527
Mailing Address - Fax:
Practice Address - Street 1:40315 MICHIGAN AVE # 1048
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2908
Practice Address - Country:US
Practice Address - Phone:734-330-4527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion