Provider Demographics
NPI:1720495229
Name:SPECIALIZED HOMECARE INC
Entity Type:Organization
Organization Name:SPECIALIZED HOMECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CICHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-944-9800
Mailing Address - Street 1:1535 HIGHWOOD E
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-1234
Mailing Address - Country:US
Mailing Address - Phone:877-944-9800
Mailing Address - Fax:248-409-0403
Practice Address - Street 1:3890 CHARLEVOIX AVE STE 160
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8420
Practice Address - Country:US
Practice Address - Phone:231-753-2700
Practice Address - Fax:231-881-9024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIALIZED HOMECARE ADVENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-16
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI87-4667092Medicaid
MI87-4667092Medicaid