Provider Demographics
NPI:1740480078
Name:PATIENT SUPPORT SERVICES
Entity type:Organization
Organization Name:PATIENT SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DICICCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-591-9500
Mailing Address - Street 1:28050 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2812
Mailing Address - Country:US
Mailing Address - Phone:248-591-9500
Mailing Address - Fax:
Practice Address - Street 1:28050 JOHN R RD
Practice Address - Street 2:
Practice Address - City:MADISON HTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2812
Practice Address - Country:US
Practice Address - Phone:248-591-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECTRUN HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness