Provider Demographics
NPI:1720268055
Name:SELF CARE MEDICAL EQUIPMENT INC.
Entity Type:Organization
Organization Name:SELF CARE MEDICAL EQUIPMENT INC.
Other - Org Name:SELF-CARE MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-850-2018
Mailing Address - Street 1:2505 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SYLVAN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48320-1535
Mailing Address - Country:US
Mailing Address - Phone:248-850-2018
Mailing Address - Fax:248-786-3370
Practice Address - Street 1:2505 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:SYLVAN LAKE
Practice Address - State:MI
Practice Address - Zip Code:48320-1535
Practice Address - Country:US
Practice Address - Phone:248-850-2018
Practice Address - Fax:248-786-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-03
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1720268055Medicaid
MI1720268055Medicaid